617例下肢深静脉血栓形成相关危险因素分析

Risk Factors Analysis in 617 Hospitalized Patients with Deep Venous Thromboembolism

目的分析下肢深静脉血栓形成（DVT）住院患者的患病情况、临床特征和危险因素。方法回顾性分析南京鼓楼医院2002年至2011年住院DVT患者的人口学特点、获得性及遗传性危险因素。结果共收集DVT患者617例,男∶女=1∶1.21,中位年龄56（12～92）岁。其中初发DVT患者550例,占89.14%,发病高峰年龄在40～70岁,其中男性高发年龄在50～70岁,女性高发年龄在40～60岁。主要获得性危险因素有外伤和（或）手术（49.1%）、初发年龄＆gt;70岁（20.7%）。其中具有多种获得性危险因素者占29.6%。104例患者在抗凝治疗前取外周血检测了蛋白C（PC）、蛋白S（PS）活性,其中的34例患者还同时检测了抗凝血酶（AT）活性。结果抗凝蛋白总缺乏率达53.8%,且以PS缺乏为主,占35.6%。同时具有遗传性和获得性危险因素者占26%。DVT患者血脂检查以甘油三酯升高、H-胆固醇降低为主;血小板平均体积（MPV）、红细胞压积、血红蛋白含量及红细胞计数,随着这四种指标值升高,DVT患病率也升高。结论住院DVT患者的初发年龄集中在40～70岁,其中女性比男性提早约10年,主要获得性危险因素为外伤和（或）手术、年龄＆gt;70岁,遗传性危险因素以PS缺乏为主。实验室检查以甘油三酯升高、H-胆固醇降低为主。多种危险因素并存是促使DVT发病的重要原因。

Objective To explore the frequency,clinical features and risk factors of deep venous thromboembolism（ DVT） in hospitalized patients. Methods The demographic features,acquired and inherited factors of in-patient cases of DVT in Nanjing Drum Tower Hospital from 2002 to 2011 were analyzed retrospectively. Results 617 patients were enrolled. Among them,male to female ratio was 1∶1. 21 and the median age was 56（ 12 ～ 92） year old. 550（ 89. 14%） patients were at their first diagnosis with the peak ages between50 and 70 for male and 40 and 60 for female. More common acquired risk factors were trauma /surgery（ 49.1%）,age（ 70 year）（ 20. 7%）. 29. 6% of the patients had more than two acquired risk factors. Before the initiation of anticoagulation therapy,the activities of protein C（ PC） and protein S（ PS） were measured in 104patients,and the activity of antithrombin（ AT） was measured in 34 patients of them. 53. 8% of the 104 patients had deficiency of these three natural anticoagulants and deficiency of PS was the commonest one（ 35. 6%）.26% of the 104 patients had inherited plus acquired risk factors. Most DVT patients were with elevated triglycerides and reduced H-cholesterol. The incidence of DVT was increasing with the increased value of mean platelet volume,hematocrit,hemoglobin content and red blood cell count. Conclusion DVT in hospitalized patients were at their first diagnosis with the peak ages between 40 and 70,and the age for the first event of DVT in women was about 10 years ahead of that in men. The major acquired risk factors were trauma /surgery,age（〉70 year）,and inherited risk factors were PS deficiency. Most DVT patients had elevated triglyceridesand reduced H-cholesterol. It seems that the coexistence of multiple risk factors plays an important role in triggering DVT.