主动脉瘤相关慢性弥散性血管内凝血的临床特点

Clinical Features of Aortic Aneurysm-associated Chronic Disseminated Intravascular Coagulation

目的探讨主动脉瘤合并慢性弥散性血管内凝血(aortic aneurysm-associated disseminated intravascular coagu-lation,AA-DIC)患者的临床特点。方法收集北京协和医院2009年9月至2011年9月收治的174例主动脉瘤住院患者的临床资料。将主动脉瘤患者根据其是否合并DIC分为AA-DIC组和non-DIC组,比较两组之间临床特点的差异。结果 174例主动脉瘤患者中,合并慢性DIC共37例(21.3%),其中典型DIC4例(2.3%),不典型DIC33例(19.0%)。AA-DIC组患者病程显著长于non-DIC组(P=0.041)。AA-DIC和non-DIC组患者动脉瘤分布部位和类型均以腹主动脉瘤和真性动脉瘤最为常见。AA-DIC组出现附壁血栓、合并动脉粥样硬化、高血压、糖尿病的发生率均显著高于non-DIC组(P均<0.01)。不典型DIC者同样存在不同程度凝血指标异常。接受肝素/低分子肝素治疗的AA-DIC患者临床症状或实验室指标均得到改善。结论主动脉瘤尤其是腹主动脉瘤无论其本身或围术期均可发生慢性DIC或出现DIC样表现。腹主动脉瘤、附壁血栓形成以及合并动脉粥样硬化、高血压、糖尿病的患者更易发生慢性DIC。对于以慢性DIC表现就诊的患者,需考虑主动脉瘤可能。

Objective To investigate the clinical features of patient with aortic aneurysm-associated chronic disseminated intravascular coagulation （AA-DIC）.Methods The clinical data of 174 hospitalized patients from Peking Union Medical College Hospital who were diagnosed with aortic aneurysm from September 2009 to September 2011 were collected.The difference between aortic aneurysm patients with DIC （AA-DIC group） and those without DIC （non-DIC group） was compared.Results Among these 174 patients with aortic aneurysm,37 cases （21.3%） were associated with chronic DIC,including 4 （2.3%） with typical DIC and 33 （19.0%） with non-typical DIC.Patients from AA-DIC group has a significantly longer course than those from the non-DIC group （P=0.041）.Abdominal aortic aneurysm and true aneurysm were most common seen in both groups.The proportion of mural thrombus and the incidences of complications including atherosclerosis,hypertension,and diabetes in the AA-DIC group were significantly higher than those in the non-DIC group （all P0.01）.Patients with non-typical DIC also had abnormal coagulation disorders of varying degrees.Heparin/low molecular weight heparin （LMWH） improved both the clinical symptoms and laboratory parameters of patients in the AA-DIC group.Conclusions Aortic aneurysm,especially abdominal aortic aneurysm,whether itself or in the perioperative period,can present as chronic DIC or coagulation disorders such as DIC.When patients with aortic aneurysm have a performance of mural thrombus formation or complicated with atherosclerosis,hypertension,or diabetes,they might appear chronic DIC.Aortic aneurysm should be considered when a patient shows manifestations of chronic DIC.