藏族静脉血栓栓塞症患者31例临床分析

目的 通过分析高原居住的藏族静脉血栓栓塞症（ VTE） 患者的临床资料, 了解藏族VTE 患者的危险因素、发病特点以及预后情况。方法 纳入2010 年1 月至2012 年12 月四川大学华西医院经CTPA 或血管彩超检查明确诊断的DVT 或PE 的长期高原居住的VTE 藏族患者, 回顾性调查患者的VTE 危险因素, 分析其临床症状、体征及实验室检查结果, 并电话随访。结果 31 例VTE患者中男16 例, 女15 例; 危险因素分析显示15 例患者（ 48. 3% ） 有肥胖体质, 10 例患者（ 32. 3% ） 有高粘血症。常见临床症状依次为呼吸困难9 例（ 29% ） , 胸痛6 例（ 19. 4% ） , 咯血5 例（ 16. 1% ） 和咳嗽咳痰4 例（ 12. 9% ） 。常见体征为下肢水肿22 例（ 73. 3% ） 和肺部啰音11 例（ 36. 7% ） 。所有患者均接受了抗凝治疗, 其中2 例给予安置下腔静脉滤器治疗。出院后2 年随访结果显示31 例患者中有4 例患者死亡, 2 例死于肿瘤, 2 例死于PE; 6 例DVT 病员出现患侧下肢间断性水肿、疼痛,1 例出现肺栓塞后肺动脉高压, 20 例患者血栓消失或机化再通, 且未再出现VTE 复发。结论 藏族患者长期居住高海拔地区, 且饮食习惯多为高脂饮食, 增加了高粘血症及肥胖等VTE 获得性危险因素。藏族VTE 患者的临床症状及体征无特异性, 呼吸困难是最常见症状, 下肢水肿为最常见体征。危险因素短期内可消除的VTE 患者预后较好。

Clinical Analysis of 31 Tibetan Patients with Venous Thromboembolism

Objective To investigate the risk factors, characteristics and prognosis in Tibetan patients with venous thromboembolism.Methods Tibetan patients with VTE fromplateau area, admitted in West China Hospital from January 2010 to December 2012, were recruited in the study. The VTE diagnosis was confirmed by CT pulmonary angiogram （ CTPA） or vascular ultrasound examination. Risk factors,clinical symptoms, signs and laboratory tests were retrospectively investigated and follow-up by telephoneinterview was conducted. Results 31 Tibetan VTE patients with 16 males and 15 females were included.The investigation of risk factors revealed that 15 patients suffered from obese（ 48. 3% ） , 10 patients suffered fromhighly viscous hyperlipidemia（ 32. 3%） . The most common clinical symptom was dyspnea（ 29% ） ,followed by chest pain（ 19. 4% ） , hemoptysis（ 16. 1% ） and cough（ 12. 9%） . The common signs were lower extremity edema（ 73. 3% ） and lung rale（ 36. 7% ） . All the patients received anticoagulation therapy, and inferior vena caval filters were implanted in 2 patients. In two years’follow-up after discharge, 2 patients died of tumor, 2 died of pulmonary embolism, 6 patients suffered from chronic embolization syndrome with lower extremity edema or pain, 1 patient suffered from pulmonary hypertension after embolization, and thrombus in 20 patients disappeared or recanalized. Conclusions Tibetans long-termly reside in high altitude areas with the eating habits of high-fat diet, which may increase the incidence of acquired risk factors such as viscous hyperlipidemia and obesity. There are no specific clinical symptoms and signs among Tibetan VTE patients, with dyspnea as the most common symptom and lower extremity edema as the most common sign. Patients with risk factors which can be eliminated in a short term have better prognosis.