《国际循环》：最近的研究报告在急性肺栓塞的治疗方面有一些令人高兴的新发现， 伴随着新的治疗手段，危险分层方法是否也应该重新修订？我们非常希望与读者分享这一方面的消息，您能就此谈一下？
 

    <International Circulation>: Reports published recently bear good news about new approaches in the management of acute pulmonary embolism， and the recommendation is for modified risk stratification prior to treatment of acute pulmonary embolism. Could you tell us more about this?

    Torbicki教授:急性肺动脉栓塞病人主要的的划分方式依然是依靠临床评估，并且评估应当在看完患者的最初的5分钟内完成，你正在寻找休克或系统的低血压并且那时你知道要做什么。处于高危状态并且被明确为休克或者低血压的患者应当接受溶栓治疗或者甚至是通过外科手术或者有时通过介入来实行栓子切除术。其他的人则是一个大的人群，比幸运的第一类人群要大得多，他们需要一些预测分层。现在我们需要区别处在低风险且没有体征表明右心室功能受损的人群，可以通过生物标记或超声心动图来达到，但是你也应当考虑其他的联合发病率。这些病人中的一些人可能非常老，以特殊治疗的观点来看，因此这些人需要较少的注意，在低分子量肝素和新的刚刚上市的复合物治疗下，他们将做得很好。问题是处在中度危险的人群-患者有右心室负荷过重，我们有所有的生物标记和尖端的显象技术，但是我们始终不清楚它的阈值。我们不清楚是否在这些患者中的亚群中仍然需要强有力治疗，并且进行强有力的治疗，我的意思是溶栓治疗。现在有一个大型的称为PEITHO（来自于希腊的希望）的全球性的试验，他所涉及的这个问题是采用随机的方法直到我们获悉试验的结果，很可能在2012年，我们不能依靠大量的分组的好的预后性的测试来推荐更多的强有力的治疗，但是我们依然没有明确的截断标准，我们已在路上，但还没有达到目标。
    Prof. Torbicki: The key way of stratifying patients with acute pulmonary embolism is still based on clinical assessment and it should be done within the first five minutes that you see a patient. You are looking for shock or systemic hypotension and then you know what to do. Those patients who are a high risk and this can be defined by the presence of shock or hypotension， should receive thrombolysis or even embolectomy by surgery or sometimes intervention. The others are a big group， much bigger than the first one fortunately， which needs some prognostic sub-stratification. We can identify now people who are at low risk who have no signs of right ventricle damage or dysfunction， and you can approach it by biomarkers or by echocardiography， but also you should consider other co-morbidities. Some of these patients might be quite old， so these people need less attention in terms of specific treatment and they will do pretty well on low-molecular-weight-heparins or new compounds that are only just now entering the market. The issue is with the intermediate risk group – patients with right ventricular overload. We have all the biomarkers and we have very sophisticated imaging techniques but we still don’t know the thresholds. We don’ t know if there is a sub-group of this group of patients who still need aggressive treatment， and by aggressive treatment I mean thrombolysis. There is a large global trial which is called PEITHO from the Greek “hope”， which addresses this issue in a randomized manner. Until we learn the results of this trial， probably in 2012， we cannot recommend more aggressive treatment based on a very large panel of good prognostic tests but still without definite cut-off criteria. We are on our way but still not at the target.