恶性淋巴瘤合并静脉血栓栓塞的临床特征及血液学指标检测

目的:了解恶性淋巴瘤（malignant lymphoma，ML）患者并发静脉血栓栓塞（venous thromboembolism ，VTE ）的临床特点及血液学指标变化情况，为预防和治疗ML合并VTE 提供有效依据。方法:回顾性分析2010年10月至2014年4 月江苏大学附属昆山医院收治的65例ML合并VTE 患者的临床资料，观察凝血功能和血液流变学等血栓相关血液学指标。结果:ML合并VTE 患者男女比例为2.6 1:1，主要集中于较晚期的患者，81.54% 病例为ⅢB～Ⅳ期。66.15%（43例）在ML确诊后发现。55例（84.62%）并发深静肿血栓形成（deep vein thrombosis，DVT ），7 例（10.77%）并发肺栓塞（pulmonary embolism，PE），仅3 例（4.62%）同时并发DVT和PE。上肢和颈部静脉为DVT 的最常见发生部位，占67.27%（37例）。 ML合并DVT 主要表现为患肢肿胀、胀痛和皮温升高，而PE患者表现为不明原因的呼吸困难、胸痛和晕厥。55例DVT 患者治疗总有效率为49.09%（27例），而PE患者仅为14.29%（1例）。 与单独ML患者相比，ML合并VTE 患者血小板聚集、D-dimer、血液高切黏度、低切黏度、血浆黏度、红细胞比容、红细胞聚集指数和刚性指数均明显升高，而APTT、血沉、变形指数和血平均流速明显降低。结论:ML合并VTE 多为DVT ，好发于男性，且集中于晚期患者，上肢和颈部静脉为好发部位，患者血液学指标向“易栓状态”变化。 

Clinical and hematological features of malignant lymphoma com-bined with venous thromboembolism

Objective: To investigate clinical and hematological features of malignant lymphoma (ML) combined with venous thromboembolism (VTE). Methods:The clinical data of 65 patients with ML combined with VTE were collected between October 2010 and April 2014 and then retrospectively reviewed. Coagulation function and hemorheology were analyzed. Results:The proportion of males and females among patients with ML combined with VTE was 2.61 :1. ML combined with VTE was mainly observed in patients with end-stage cancer. The highest incidence ( 81.54%) of ML combined with VTE was found in StageⅢB-Ⅳtumor. Among 65patients with VTE, 43 (66 .15 %) were found after ML was diagnosed, 55 (84 .62 %) were deep vein thrombosis (DVT),7 (10 .77 %) were pulmonary embolism (PE), and 3 (4.62 %) were complicated with both DVT and PE. Common DVT locations were the upper limb and the neck vein of 37 cases ( 67 .27 %). Clinical manifestations of ML combined with DVT are limb pain, swelling, and increased skin temperature. Unexplained difficulty in breathing, chest pain, and syncope are also found in ML combined with PE. The total effective rate of55 cases with DVT was49 .09 %, and the rate of those cases with PE was 14 .29 %. The levels of platelet aggregation, D-dimer, high cut blood viscosity, low cut blood viscosity, plasma viscosity, hematocrit, assembly index of erythrocyte, and rigidity index of erythrocyte were significantly higher in patients with ML combined with VTE than in patients with ML alone; by contrast, APTT, erythrocyte sedimentation rate, deformability index of erythrocyte, and average velocity of blood flow were reduced in patients with ML combined with VTE than in patients with ML alone. Conclusion: DVT, which exhibits high incidence in males, is the most common type observed in ML combined with VTE. DVT is commonly manifested in the upper limb and the neck vein; furthermore, DVT is mainly observed in patients with end-stage cancer. Hematological indexes indicated changes in the sensitivity state of thromboembolism.