左髂静脉受压与左下肢深静脉血栓的相关性研究

Correlation between left iliac vein compression and left limb deep vein thrombosis

目的 用计算机断层扫描（CT）评估下肢深静脉血栓形成（deep vein thrombosis,DVT）患者和正常人群的左髂静脉（LCIV）短径和狭窄率,并探讨其与左下肢DVT的相关性.方法 回顾性分析19例右下肢DVT、60例左下肢DVT病例和218例正常人的CT影像结果,测量和计算左髂静脉受压综合征（iliac vein compression syndrome,IVCS）短径和狭窄率.采用多因素回归分析LCIV短径和狭窄率与左下肢DVT发生的相关性.结果 对照组51.8％人群LCIV受压率＞50％,24.3％LCIV受压率＞70％;女性LCIV短径[（4.7±2.7）mm]明显小于男性[（6.6±3.3）mm,P＜0.01）].左下肢DVT组LCIV短径[（2.4±1.0）mm]明显小于对照组[（5.4±3.1） mm,P＜0.01）]和右下肢DVT组[（6.2±1.8）mm,P＜0.01],其LCIV狭窄率[（78±8）％]明显高于对照组[（49±25）％,P＜0.01）]和右下肢DVT组[（38±21）％,P＜0.01）].LCIV短径每减少1 mm,左下肢DVT发生的相对危险度OR值为2.69（P＜0.001,95％ CI为1.91 ～3.77）;LCIV狭窄率每增加10％,左下肢DVT发生的OR值为2.78（P＜0.001,95％ CI为1.95～3.96）.当LCIV狭窄率＞75％时,左下肢DVT发生风险增加10.12倍;当LCIV短径＜2.5 mm时,左下肢DVT发生风险增加13.57倍.结论 LCIV受压是左下肢DVT发生的独立危险因素;LCIV明显受压患者,是左下肢DVT高危人群.

Objective By using computer tomography （CT） to evaluate the left common iliac vein （LCIV） minor diameter and stenosis in deep vein thrombosis （DVT） patients and normal population,and to explore the correlation between LCIV compression and left-sided DVT.Methods Measurement and calculation of LCIV minor diameter and stenosis were conducted in 19 right-sided DVT,60 left-sided DVT and 218 control subjects.Multiple factors regression analysis was used to study the correlation of LCIV minor diameter and stenosis with left-sided DVT.Results In control group,51.8％ had greater than 50％ compression of LCIV,and 24.3％ had greater than 70％ compression.LCIV diameter in women [（4.7 ± 2.7） mm] was significantly smaller than that of men [（6.6 ± 3.3） mm,P ＜ 0.05）].LCIV diameter in leftsided DVT [（2.4 ± 1.0） mm] was significantly smaller than that in control group [（5.4 ± 3.1） mm,P ＜0.001）] or right-sided DVT [（6.2 ± 1.8） mm,P ＜0.01].LCIV stenosis in left-sided DVT [（78 ±8） ％]was higher than that in control group [（49 ±25）％,P ＜0.01）] or right-sided DVT [（38 ±21）％,P ＜0.01）].The odds of left DVT increased by a factor of 2.69 for each millimeter decrease in LCIV diameter （P ＜ 0.001,95％ CI 1.91-3.77）,and 2.78 for each ten percent increase in LCIV stenosis （P ＜ 0.001,95％ CI 1.95-3.96）.With LCIV stenosis ＞75％,the risk of left DVT was associated with an 11.10-fold increase,and with LCIV diameter ＜ 2.5 mm,the risk was associated with a 13.57-fold increase.Conclusions LCIV compression was an independent risk factor for left-sided DVT.Patients with severe LCIV compression were at high risk for left-sided DVT.