目的分析静脉血栓栓塞症(VTE)住院患者的患病情况、临床特征和危险因素。方法回顾性分析北京协和医院1994年至2004年住院 VTE 病例的患病趋势、人口学特点、获得性及遗传性危险因素。结果共收集 VTE 患者672例,男:女=1.2:1,中位年龄53(1...目的分析静脉血栓栓塞症(VTE)住院患者的患病情况、临床特征和危险因素。方法回顾性分析北京协和医院1994年至2004年住院 VTE 病例的患病趋势、人口学特点、获得性及遗传性危险因素。结果共收集 VTE 患者672例,男:女=1.2:1,中位年龄53(14～92)岁。初发患者580例(86.3%),发病高峰年龄男性患者为40～50岁,女性为50～60岁。主要获得性危险因素有抗磷脂抗体阳性(32.0%)、外伤和(或)手术(31.1%)、肿瘤(17.1%)。其中具有多种获得性危险因素者占35.7%。94例患者在抗凝治疗前取外周血检测了蛋白 C(PC)、蛋白 S(PS)和抗凝血酶(AT)活性。抗凝蛋白总缺陷率为44.7%,以 PC 缺乏以及 PC 与 AT 联合缺乏为主,分别占13.8%和10.6%。同时具有遗传和获得性危险因素者占31.6%。结论研究结果显示综合医院的住院 VTE 病例数呈逐年上升趋势,男性 VTE 患者的初发年龄较女性提早约10年。主要获得性危险因素为抗磷脂抗体阳性、外伤或手术和肿瘤,而遗传性危险因素则以 PC 缺乏和 PC 与 AT 联合缺乏为主。多种危险因素并存是促发 VTE 的重要原因。展开更多
The thrombophilia in adult life has major implications in the hepatic vessels. The resulting portal vein thrombosis has various outcomes and complications. Esophageal varices, portal gastropathy, ascites, severe hyper...The thrombophilia in adult life has major implications in the hepatic vessels. The resulting portal vein thrombosis has various outcomes and complications. Esophageal varices, portal gastropathy, ascites, severe hypersplenism and liver failure needing liver transplantation are known well. The newly formed collateral venous circulation showing itself as pseudocholangicarcinoma sign and its possible clinical reflection as cholestasis are also known from a long time. The management strategies for these complications of portal vein thrombosis are not different from their counterpart which is cirrhotic portal hypertension, but the prognosis is unquestionably better in former cases. In this review we present and discuss the portal vein thrombosis, etiology and the resulting dinical pictures. There are controversial issues in nomenclature, management （including anticoagulation problems）, follow up strategies and liver transplantation. In the light of the current knowledge, we discuss some controversial issues in literature and present our experience and our proposals about this group of patients.展开更多
目的探讨D-二聚体(D-dimer,D-D)、纤维蛋白原(fibrinogen,FIB)与血小板(platelet,PLT)联合检测对骨折患者术前血液高凝状态的诊断价值。方法选择2018年10月至2019年12月在重庆医科大学附属永川医院就诊的149例术前尚未抗凝骨折患者作为...目的探讨D-二聚体(D-dimer,D-D)、纤维蛋白原(fibrinogen,FIB)与血小板(platelet,PLT)联合检测对骨折患者术前血液高凝状态的诊断价值。方法选择2018年10月至2019年12月在重庆医科大学附属永川医院就诊的149例术前尚未抗凝骨折患者作为研究对象,收集患者的一般临床资料和血液学指标,根据血栓弹力图(thrombelastogram,TEG)结果分为高凝状态组60例和非高凝状态组89人例。运用SPSS17.0将相关指标进行统计学分析,比较两组患者上述指标的差异。多因素分析采用二元Logistic回归,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线,分析D-D、FIB、PLT三者联合检测在骨折患者术前血液高凝状态中的诊断效能。结果(1)骨折术前高凝状态组血浆FIB、D-D、纤维蛋白(原)降解产物水平、PLT计数高于非高凝状态组,差异有统计学意义(P<0.05)。(2)ROC曲线下面积(area under the ROC curve,AUC)分析,三者联合检测AUC高于单独检测D-D、FIB及PLT,差异有统计学意义(P<0.05);虽三者联合检测AUC高于D-D+FIB、D-D+PLT、FIB+PLT联合检测AUC、高于单独检测D-D、FIB及PLT,D-D+PLT联合检测AUC高于单独检测D-D、FIB及PLT,但差异均无统计学意义(P>0.05);FIB+PLT联合检测AUC低于单独检测D-D。结论骨折术前,D-D、FIB、PLT联合检测可提高患者高凝状态的诊断效能,具有诊断高凝状态的重要价值。展开更多
The thrombophilia which can be either congenital or acquired in adult life has major implications in the abdominal vessels. The resulting portal vein thrombosis, Budd-Chiari syndrome and mesenteric vein thrombosis hav...The thrombophilia which can be either congenital or acquired in adult life has major implications in the abdominal vessels. The resulting portal vein thrombosis, Budd-Chiari syndrome and mesenteric vein thrombosis have a variety of consequences ranging from acute abdomen to chronic hepatomegaly and even totally asymp- tomatic patient in whom the only finding is pancytopenia. The complications like esophageal varices, portal gastropathy, ascites, severe hypersplenism, liver failure requiring liver transplantation are well known. Interesting features of collateral venous circulation showing itself as pseudocholangiocarcinoma sign and its possible clinical reflection as cholestasis are also known from a long time. The management strategies for these complications of intraabdominal vessel thrombosis are not different from their counterpart which is cirrhotic portal hypertension, but the prognosis is unquestionably better in former cases. In this review we presented and discussed the abdominal venous thrombosis, etiology and the resulting clinical pictures. There are controversial issues both in nomenclature, and management including anticoagulation problems and follow up strategies. In light of the current knowledge, we discussed some controversial issues in literature and presented our experience and our proposals about this group of patients.展开更多
文摘目的分析静脉血栓栓塞症(VTE)住院患者的患病情况、临床特征和危险因素。方法回顾性分析北京协和医院1994年至2004年住院 VTE 病例的患病趋势、人口学特点、获得性及遗传性危险因素。结果共收集 VTE 患者672例,男:女=1.2:1,中位年龄53(14～92)岁。初发患者580例(86.3%),发病高峰年龄男性患者为40～50岁,女性为50～60岁。主要获得性危险因素有抗磷脂抗体阳性(32.0%)、外伤和(或)手术(31.1%)、肿瘤(17.1%)。其中具有多种获得性危险因素者占35.7%。94例患者在抗凝治疗前取外周血检测了蛋白 C(PC)、蛋白 S(PS)和抗凝血酶(AT)活性。抗凝蛋白总缺陷率为44.7%,以 PC 缺乏以及 PC 与 AT 联合缺乏为主,分别占13.8%和10.6%。同时具有遗传和获得性危险因素者占31.6%。结论研究结果显示综合医院的住院 VTE 病例数呈逐年上升趋势,男性 VTE 患者的初发年龄较女性提早约10年。主要获得性危险因素为抗磷脂抗体阳性、外伤或手术和肿瘤,而遗传性危险因素则以 PC 缺乏和 PC 与 AT 联合缺乏为主。多种危险因素并存是促发 VTE 的重要原因。
文摘The thrombophilia in adult life has major implications in the hepatic vessels. The resulting portal vein thrombosis has various outcomes and complications. Esophageal varices, portal gastropathy, ascites, severe hypersplenism and liver failure needing liver transplantation are known well. The newly formed collateral venous circulation showing itself as pseudocholangicarcinoma sign and its possible clinical reflection as cholestasis are also known from a long time. The management strategies for these complications of portal vein thrombosis are not different from their counterpart which is cirrhotic portal hypertension, but the prognosis is unquestionably better in former cases. In this review we present and discuss the portal vein thrombosis, etiology and the resulting dinical pictures. There are controversial issues in nomenclature, management （including anticoagulation problems）, follow up strategies and liver transplantation. In the light of the current knowledge, we discuss some controversial issues in literature and present our experience and our proposals about this group of patients.
文摘目的探讨D-二聚体(D-dimer,D-D)、纤维蛋白原(fibrinogen,FIB)与血小板(platelet,PLT)联合检测对骨折患者术前血液高凝状态的诊断价值。方法选择2018年10月至2019年12月在重庆医科大学附属永川医院就诊的149例术前尚未抗凝骨折患者作为研究对象,收集患者的一般临床资料和血液学指标,根据血栓弹力图(thrombelastogram,TEG)结果分为高凝状态组60例和非高凝状态组89人例。运用SPSS17.0将相关指标进行统计学分析,比较两组患者上述指标的差异。多因素分析采用二元Logistic回归,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线,分析D-D、FIB、PLT三者联合检测在骨折患者术前血液高凝状态中的诊断效能。结果(1)骨折术前高凝状态组血浆FIB、D-D、纤维蛋白(原)降解产物水平、PLT计数高于非高凝状态组,差异有统计学意义(P<0.05)。(2)ROC曲线下面积(area under the ROC curve,AUC)分析,三者联合检测AUC高于单独检测D-D、FIB及PLT,差异有统计学意义(P<0.05);虽三者联合检测AUC高于D-D+FIB、D-D+PLT、FIB+PLT联合检测AUC、高于单独检测D-D、FIB及PLT,D-D+PLT联合检测AUC高于单独检测D-D、FIB及PLT,但差异均无统计学意义(P>0.05);FIB+PLT联合检测AUC低于单独检测D-D。结论骨折术前,D-D、FIB、PLT联合检测可提高患者高凝状态的诊断效能,具有诊断高凝状态的重要价值。
基金Supported by Hacettepe University Office of Scientific Research Center
文摘The thrombophilia which can be either congenital or acquired in adult life has major implications in the abdominal vessels. The resulting portal vein thrombosis, Budd-Chiari syndrome and mesenteric vein thrombosis have a variety of consequences ranging from acute abdomen to chronic hepatomegaly and even totally asymp- tomatic patient in whom the only finding is pancytopenia. The complications like esophageal varices, portal gastropathy, ascites, severe hypersplenism, liver failure requiring liver transplantation are well known. Interesting features of collateral venous circulation showing itself as pseudocholangiocarcinoma sign and its possible clinical reflection as cholestasis are also known from a long time. The management strategies for these complications of intraabdominal vessel thrombosis are not different from their counterpart which is cirrhotic portal hypertension, but the prognosis is unquestionably better in former cases. In this review we presented and discussed the abdominal venous thrombosis, etiology and the resulting clinical pictures. There are controversial issues both in nomenclature, and management including anticoagulation problems and follow up strategies. In light of the current knowledge, we discussed some controversial issues in literature and presented our experience and our proposals about this group of patients.
