静脉血栓栓塞症患者易栓症的临床研究
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摘要
目的探讨我国静脉血栓栓塞症(VTE)患者易栓症的发生情况,以提高临床医生对VTE的诊断及预防水平。方法对2015年11月至2016年11月在沈阳军区总医院诊治的138例VTE患者的易栓症进行回顾性分析。结果 138例患者中男性82例,女性56例,平均年龄63.99±12.87岁。获得性易栓症中居前3位的是年龄(≥65岁)、高血压、近3月心梗、心衰及房颤,其发生率分别为54.3%、45.7%及12.3%。遗传性易栓症中血同型半胱氨酸升高为25例(18.1%),抗凝蛋白缺陷总的发生率为62例(44.9%)。单纯抗凝蛋白缺陷以PS缺陷最多,为25例(18.1%),AT缺陷7例(5.1%),PC缺陷6例(4.3%);复合缺陷24例(17.4%),其中PC+PS 12例,AT-III+PS 5例,AT-III+PC 4例,AT-III+PS+PC 3例。抗凝蛋白缺陷男、女分别为33例和29例,抗凝蛋白缺陷率性别间差异无统计学意义(P=0.18)。结论我国VTE患者易栓症的发生率高,遗传性易栓症以抗凝蛋白缺陷为主,不同于西方国家,存在种族差异。
Objective To explore the incidence of thrombophilia of Chinese patients with VTE,and to improve the diagnosis and prevention of VTE. Methods From November 2015 to November 2016,138 VTE patients( 82 male and 56 female) in the General Hospital of Shenyang Military Region were enrolled in our study. Results Age,hypertension and heart disease were more common acquired thrombophilia,and the incidence were 54. 3%,45. 7% and 2. 3% respectively. 25 patients with VTE( 18. 1%) had hyperhomocysteinemia,and 62 patients with VTE( 44. 9%) were found to be anticoagulant proteins deficiency. The most common deficiency was PS deficiency( 18. 1%). 24 cases( 17. 4%) were combined deficiency,and the most common was combined PC and PS( 12 cases). There was no significant difference between the two sex( P > 0. 05). Conclusion The incidence of thrombophilia in VTE patients is higher. The major deficiencies of inherited thrombophilia in Chinese patients with VTE are anticoagulant proteins deficiency,which suggests that the etiology of inherited thrombophilia may be different from that of western counties.
Objective To explore the incidence of thrombophilia of Chinese patients with VTE,and to improve the diagnosis and prevention of VTE. Methods From November 2015 to November 2016,138 VTE patients( 82 male and 56 female) in the General Hospital of Shenyang Military Region were enrolled in our study. Results Age,hypertension and heart disease were more common acquired thrombophilia,and the incidence were 54. 3%,45. 7% and 2. 3% respectively. 25 patients with VTE( 18. 1%) had hyperhomocysteinemia,and 62 patients with VTE( 44. 9%) were found to be anticoagulant proteins deficiency. The most common deficiency was PS deficiency( 18. 1%). 24 cases( 17. 4%) were combined deficiency,and the most common was combined PC and PS( 12 cases). There was no significant difference between the two sex( P > 0. 05). Conclusion The incidence of thrombophilia in VTE patients is higher. The major deficiencies of inherited thrombophilia in Chinese patients with VTE are anticoagulant proteins deficiency,which suggests that the etiology of inherited thrombophilia may be different from that of western counties.
引文
[1]中华医学会血液学分会血栓与止血学组.易栓症诊断中国专家共识(2012版)[S].中华血液学杂志,2012,33(11):982.
[2]Konstantinides SV.2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism[J].Eur Heart J,2014,35(41):2855-2863.
[3]秦小玉,宋燕,陈宁恒,等.静脉血栓栓塞症患者血清AT3、蛋白C、蛋白S水平临床分析[J].中国医药科学,2014,4(1):12-14.
[4]靳会敏,李方超,佟倩.中国静脉血栓栓塞症患者抗凝血酶-Ⅲ基因单核苷酸多态性的研究进展[J].中国免疫学杂志,2014,30(4):570-571,574.
[5]吴章明.高同型半胱氨酸血症与血栓形成的相关性研究进展[J].齐齐哈尔医学院学报,2016,37(29):3689-3690.
[6]王增智,赵秀清,郭伟,等.肺血栓栓塞症患者易栓症的分析研究[J].心肺血管病杂志,2010,29(5):357-359.
[7]白春梅,潘家绮,范连凯.静脉血栓患者抗凝蛋白缺陷研究[J].中华内科杂志,2000,39(11):746-748.
[8]张大伟,侯玉芬,闫宗廷,等.142例静脉血栓栓塞症患者中遗传性抗凝血酶缺陷症的研究[J].血栓与止血学,2010,16(6):272-274.
[9]Ridker PM,Hennekens CH,Selhub J,et al.Interrelation of hyperhomocyst(e)inemia,factor V Leiden,and risk of future venous thromboembolism[J].Circulation,1997,95(7):1777-1782.
[10]Nicolaides AN,Breddin HK,Carpenter P,et al.Thrombophilia and venous thromboembolism.International consensus statement.Guidelines according to scientific evidence[J].Int Angiol,2005,24(1):1-26.
[11]Simioni P,Prandoni P,Lensing AW,et al.Risk for subsequent venous thromboembolic complications in carriers of the prothrombin or the factor V gene mutation with a first episode of deep-vein thrombosis[J].Blood,2000,96(10):3329-3333.
[2]Konstantinides SV.2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism[J].Eur Heart J,2014,35(41):2855-2863.
[3]秦小玉,宋燕,陈宁恒,等.静脉血栓栓塞症患者血清AT3、蛋白C、蛋白S水平临床分析[J].中国医药科学,2014,4(1):12-14.
[4]靳会敏,李方超,佟倩.中国静脉血栓栓塞症患者抗凝血酶-Ⅲ基因单核苷酸多态性的研究进展[J].中国免疫学杂志,2014,30(4):570-571,574.
[5]吴章明.高同型半胱氨酸血症与血栓形成的相关性研究进展[J].齐齐哈尔医学院学报,2016,37(29):3689-3690.
[6]王增智,赵秀清,郭伟,等.肺血栓栓塞症患者易栓症的分析研究[J].心肺血管病杂志,2010,29(5):357-359.
[7]白春梅,潘家绮,范连凯.静脉血栓患者抗凝蛋白缺陷研究[J].中华内科杂志,2000,39(11):746-748.
[8]张大伟,侯玉芬,闫宗廷,等.142例静脉血栓栓塞症患者中遗传性抗凝血酶缺陷症的研究[J].血栓与止血学,2010,16(6):272-274.
[9]Ridker PM,Hennekens CH,Selhub J,et al.Interrelation of hyperhomocyst(e)inemia,factor V Leiden,and risk of future venous thromboembolism[J].Circulation,1997,95(7):1777-1782.
[10]Nicolaides AN,Breddin HK,Carpenter P,et al.Thrombophilia and venous thromboembolism.International consensus statement.Guidelines according to scientific evidence[J].Int Angiol,2005,24(1):1-26.
[11]Simioni P,Prandoni P,Lensing AW,et al.Risk for subsequent venous thromboembolic complications in carriers of the prothrombin or the factor V gene mutation with a first episode of deep-vein thrombosis[J].Blood,2000,96(10):3329-3333.