溃疡性结肠炎合并多发栓塞一例及文献复习

Ulcerative Colitis Complicating with Multiple Venous Thromboembolism:One Case Report and Literature Review

目的提高临床医师对溃疡性结肠炎合并静脉血栓栓塞症(VTE)的诊疗水平。方法对1例溃疡性结肠炎合并多发血栓栓塞病例的临床表现、实验室检查、影像学特征、治疗策略、药物选择、预后转归等方面进行病例分析及文献复习。结果溃疡性结肠炎合并多发栓塞患者因不正规治疗导致肺血栓栓塞(PTE)复发,除发生下肢深静脉血栓形成外,还发现肠系膜上静脉栓塞(MVT),肝素(UFH)、低分子肝素(LMWH)治疗出血风险低,而华法林治疗出血风险大。结论炎症性肠病(IBD)与VTE关系密切,但症状不典型,易漏诊和误诊,IBD患者发生"来源不明"的肺栓塞,需注意排查肠系膜静脉栓塞(MVT)。IBD合并VTE治疗有出血风险,需根据其严重程度及风险效益选择合适药物。

Objective To improve the knowledge of inflammatory bowel disease complicated with venous thromboembolism for better diagnosis and treatment.Methods One case of patient with ulcerative colitis complicated with a multiple vessel thromboembolism（pulmonary arterial,deep vein of lower limb,and superior mesenteric vein） was analyzed,and related literatures were reviewed.Results The patient resulted in pulmonary thromboembolism（PTE） recurrence because of irregular treatment.In addition to deep vein thrombosis of the lower extremity,a new discovery of the superior mesenteric vein embolism（MVT） was diagnosed.The bleeding risk of heparin or low molecular weight heparin（LMWH） for treatment is low,while that of warfarin is high.Conclusions Venous thromboembolism（VTE） has a close relationship with inflammatory bowel disease（IBD） such as ulcerative colitis.The symptom is not so typical that it is easy to misdiagnosis and missed diagnosis.It is noted that mesenteric venous thrombosis（MVT） should be excluded in IBD patients suffering from VTE,if the source of embolus is not clear.Suitable treatment should be considered according to the risk stratification of VTE and risk-benefit ratio because of a high bleeding risk.