摘要
静脉血栓栓塞症(VTE)包括深静脉血栓形成(DVT)和肺栓塞(PE),其发生率随着年龄的增高而显著上升,老年人是VTE的高危人群。随着人口老龄化加剧,老年VTE患者势必不断增多。明确老年人VTE危险因素,及时采取有效预防措施,具有重要的现实意义。本文综述了与老年人VTE发生较为密切的一些因素,包括制动相关危险因素、癌症、老年人常见慢性病、慢性静脉功能不全、衰弱综合征等,以期发现其特点,为老年人VTE预防提供可靠的临床参考。
Venous thromboembolism(VTE) includes deep vein thrombosis(DVT) and pulmonary embolism(PE).As its incidence increases significantly with age,old people are at high risk.With the aging of population,there would be more and more elderly patients suffering from VTE.So,it is of great practical significance to identify the risk factors for VTE in the elderly so as to take effective preventive measures in time.In this review,some factors related to the occurrence of VTE in the aged have been summarized,including immobility-related risk factors,cancer,common chronic diseases in the elderly,chronic venous insufficiency and frailty syndrome,in order to find out their characteristics and provide reliable clinical references for the prevention of VTE in the elderly.
引文
[1]Naess IA,Christiansen SC,Romundstad P,et al.Incidence and mortality of venous thrombosis:a population-based study[J].J Thromb Haemost,2007,5(4):692-699.DOI:10.1111/j.1538-7836.2007.02450.x.
[2]Tagalakis V,Patenaude V,Kahn SR,et al.Incidence of and mortality from venous thromboembolism in a real-world population:the Q-VTE Study Cohort[J].Am J Med,2013,126(9):e813-832.DOI:10.1016/j.amjmed.2013.02.024.
[3]Majluf-Cruz A,Castro Martinez G,Comejo H,et al.Awareness regarding venous thromboembolism among internal medicine practitioners in Mexico:a national cross-sectional study[J].Intem Med J,2012,42(12):1335-1341.DOI:10.1111/j.1445-5994.2011.02646.x.
[4]Hull RD.Relevance of immobility and importance of risk assessment management for medically ill patients[J].Clin Appl Thromb Hemost,2013,19(3):268-276.DOI:10.1177/1076029612452781.
[5]Pottier P,Hardouin JB,Lejeune S,et al.Immobilization and the risk of venous thromboembolism:a meta-analysis on epidemiological studies[J].Thromb Res,2009,124(4):468-476.DOI:10.1016/j.thromres.2009.05.006.
[6]Engbers MJ,Blom JW,Cushman M,et al.The contribution of immobility risk factors to the incidence of venous thrombosis in an older population[J].J Thromb Haemost,2014,12(3):290-296.DOI:10.1111/jth.12480.
[7]Blom JW,Doggen CJM,Osanto S,et al.Malignancies,prothrombotic mutations,and the risk of venous thrombosis[J].JAMA,2005,293(6):715-722.DOI:10.1001/jama.293.6.715.
[8]Spirk D,Aujesky D,Stuck AK,et al.Clinical outcomes of venous thromboembolism in patients with and without cancer:the SWIss Venous ThromboEmbolism Registry(SWIVTER)[J].Semin Thromb Hemost,2016,42(6):642-649.DOI:10.1055/s-0036-1584131.
[9]叶建荣,施德兵,符伟国,等.44例恶性肿瘤并发下肢深静脉血栓形成的发病时间与原因探讨[J].中华老年多器官疾病杂志,2005,4(2):110-117.Ye JR,Shi DB,Fu WG,et al.The onset time and cause of lower limb DVT in malignant tumor patient:report of 44 cases[J].Chin J Mult Organ Dis Elderly,2005,4(2):110-117.
[10]Mereu L,Tateo S,Hersy C,et al.Stratification of venous thromboembolism risk in ovarian cancer patients during chemotherapy[J].Int J Gynecol Cancer,2009,19(1):79-83.DOI:10.1111/IGJ.0b013e318199035e.
[11]Petterson TM,Marks RS,Ashrani AA,et al.Risk of site-specific cancer in incident venous thromboembolism:a population-based study[J].Thromb Res,2015,135(3):472-478.DOI:10.1016/j.thromres.2014.12.013.
[12]Paneesha S,McManus A,Arya R,et al.Frequency,demographics and risk(according to tumour type or site)of cancer-associated thrombosis among patients seen at outpatient DVT clinics[J].Thromb Haemost,2010,103(2):338-343.DOI:10.1160/TH09-06-0397.
[13]Dogan M,Demirkazik A.Venous thromboembolism in patients with cancer and its relationship to the coagulation cascade and vascular endothelial growth factor[J].Support Cancer Ther,2005,3(1):28-34.DOI:10.3816/SCT.2005.n.022.
[14]Mozaffarian D,Benjamin EJ,Go AS,et al.Heart disease and stroke statistics—2015 update:a report from the American Heart Association[J].Circulation,2015,131(4):e29-e322.DOI:10.1161/CIR.0000000000000152.
[15]Tang L,Wu YY,Lip GY,et al.Heart failure and risk of venous thromboembolism:a systematic review and meta-analysis[J].Lancet Haematol,2016,3(1):e30-e44.DOI:10.1016/S2352-3026(15)00228-8.
[16]Weill-Engerer S,Meaume S,Lahlou A,et al.Risk factors for deep vein thrombosis in inpatients aged 65 and older:a casecontrol multicenter study[J].J Am Geriatr Soc,2004,52(8):1299-1304.DOI:10.1111/j.1532-5415.2004.52359.x.
[17]Haskins IN,Amdur R,Sarani B,et al.Congestive heart failure is a risk factor for venous thromboembolism in bariatric surgery[J].Surg Obes Relat Dis,2015,11(5):1140-1145.DOI:10.1016/j.soard.2014.12.020.
[18]Dean SM,Abraham W.Venous thromboembolic disease in congestive heart failure[J].Congest Heart Fail,2010,16(4):164-169.DOI:10.1016/j.soard.2014.12.020.
[19]Schmidt M,Jacobsen JB,Johnsen SP,et al.Eighteen-year trends in stroke mortality and the prognostic influence of comorbidity[J].Neurology,2014,82(4):340-350.DOI:10.1212/WNL.0000000000000062.
[20]Corraini P,Ording AG,Henderson VW,et al.Cancer,other comorbidity,and risk of venous thromboembolism after stroke:a population-based cohort study[J].Thromb Res,2016,147:88-93.DOI:10.1016/j.thromres.2016.09.029.
[21]陈彦.老年患者脑卒中后下肢深静脉血栓形成的危险因素[J].中国老年学杂志,2011,31(21):4237-4238.DOI:10.3969/j.issn.1005-9202.2011.21.070.Chen Y.Risk factors of lower extremity deep venous thrombosis in elderly patients after stroke[J],Chin J Gerontol,2011,31(21):4237-4238.DOI:10.3969/j.issn.1005-9202.2011.21.070.
[22]Stein PD,Beemath A,Meyers FA,et al.Pulmonary embolism and deep venous thrombosis in hospitalized adults with chronic obstructive pulmonary disease[J].J Cardiovasc Med,2007,8(4):253-257.DOI:10.2459/01.JCM.0000263509.35573.2c.
[23]Borvik T,Braekkan SK,Enga K,et al.COPD and risk of venous thromboembolism and mortality in a general population[J].Eur Respir J,2016,47(2):473-481.DOI:10.1183/13993003.00402-2015.
[24]Bertoletti L,Quenet S,Mismetti P,et al.Clinical presentation and outcome of venous thromboembolism in COPD[J].Eur Respir J,2012,39(4):862-868.DOI:10.1183/09031936.00058811.
[25]白冬波.慢性阻塞性肺疾病急性加重期并发静脉血栓栓塞症的危险因素及预防[J].血栓与止血学,2016,22(3):270-272.DOI:9-6213(2016)03-270-03.Bai DB.Risk factors and preventive intervention for acute exacerbation of chronic obstructive pulmonary disease with venus thromboembolism[J].Chin J Thromb Hemost,2016,22(3):270-272.DOI:9-6213(2016)03-270-03.
[26]白久武,高蓓兰,徐金富,等.老年慢性阻塞性肺疾病急性加重期继发肺栓塞和/或深静脉血栓的机制研究[J].中华全科医师杂志,2014,1(6):448-451.DOI:10.3760/cma.j.issn.1671-7368.2014.06.007.Bai JW,Gao BL,Xu JF,et al.Mechanisms of pulmonary embolism and/or deep vein thrombosis secondary to chronic obstructive pulmonary disease exacerbation in elders[J].Chin J Gen Pract,2014,1(6):448-451.DOI:10.3760/cma.j.issn.1671-7368.2014.06.007.
[27]Xu Y,Wang L,He J,et al.Prevalence and control of diabetes in Chinese adults[J].JAMA,2013,310(9):948-959.DOI:10.1001/jama.2013.168118.
[28]Ageno W,Becattini C,Brighton T,et al.Cardiovascular risk factors and venous thromboembolism:a meta-analysis[J].Circulation,2008,117(1):93-102.DOI:10.1161/CIRCULATIONAHA.107.709204.
[29]Bai J,Ding X,Du X,et al.Diabetes is associated with increased risk of venous thromboembolism:a systematic review and metaanalysis[J].Thromb Res Jan,2015,135(1):90-95.DOI:10.1016/j.thromres.2014.11.003.
[30]Gariani K,Mavrakanas T,Combescure C,et al.Is diabetes mellitus a risk factor for venous thromboembolism?A systematic review and meta-analysis of case-control and cohort studies[J].Eur J Intern Med,2016,28:52-58.DOI:10.1016/j.ejim.2015.10.001.
[31]Keenan CR,Murin S,White RH.High risk for venous thromboembolism in diabetics with hyperosmolar state:comparison with other acute medical illnesses[J].J Thromb Haemost,2007,5(6):1185-1190.DOI:10.1111/j.1538-7836.2007.02553.x.
[32]Beebe-Dimmer JL,Pfeifer JR,Engle JS,et al.The epidemiology of chronic venous insufficiency and varicose veins[J].Ann Epidemiol,2005,15(3):175-184.DOI:10.1016/j.annepidem.2004.05.015.
[33]Decousus H,Frappe P,Accassat S,et al.Epidemiology,diagnosis,treatment and management of superficial-vein thrombosis of the legs[J].Best Pract Res Clin Haematol,2012,25(3):275-284.DOI:10.1016/j.eha.2012.07.005.
[34]Engbers MJ,Karasu A,Blom JW,et al.Clinical features of venous insufficiency and the risk of venous thrombosis in older people[J].Br J Haematol,2015,171(3):417-423.DOI:10.1111/bjh.13579.
[35]Clegg A,Young J,Iliffe S,et al.Frailty in elderly people[J].Lancet,2013,381(9868):752-762.DOI:10.1016/S0140-6736(12)62167-9.
[36]Pel-Littel RE,Schuurmans MJ,Emmelot-Vonk MH,et al.Frailty:defining and measuring of a concept[J].JNHA,2009,13(4):390-394.
[37]Folsom AR,Boland LL,Cushman M,et al.Frailty and risk of venous thromboembolism in older adults[J].J Gerontol A Biol Sci Med Sci,2007,62(1):79-82.
[38]Soysal P,Stubbs B,Lucato P,et al.Inflammation and frailty in the elderly:a systematic review and meta-analysis[J].Ageing Res Rev,2016,31:1-8.DOI:10.1016/j.arr.2016.08.006.
[39]Weingarz L,Schwonberg J,Schindewolf M,et al.Prevalence of thrombophilia according to age at the first manifestation of venous thromboembolism:results from the MAISTHRO registry[J].Br J Haematol,2013,163(5):655-665.DOI:10.1111/bjh.12575.
