多发性肌炎/皮肌炎伴发静脉血栓栓塞23例临床分析

Clinical analysis of polymyositis/dermatomyositis complicated with venous thromboembolism： a report of 23 cases

目的 研究PM/DM伴发静脉血栓栓塞（VTE）的临床特点及可能危险因素.方法 回顾性分析2000年1月至2014年10月间北京协和医院收住院的成人PM/DM患者中伴发VTE者临床资料,采用t检验、x2检验进行数据分析.结果 PM/DM伴发VTE者23例,占同期住院PM/DM的1.86％（23/1 235）.其中PM 5例,DM 18例;男性5例,女性18例.PM与DM之间发生静脉血栓栓塞的比例差异无统计学意义,男女之间发生静脉血栓栓塞的比例差异亦无统计学意义.23例VTE患者年龄47～71岁,平均（57±7）岁,比未发生血栓的PM/DM住院患者的平均年龄（47±13）岁大（t=-3.191,P=0.001）.75％（21/28）的VTE发生在PM/DM确诊后的1年内.发生VTE者中,深静脉血栓（DVT） 18例（占1.46％,18/1 235）;肺血栓栓塞（PTE）9例（占0.73％,9/1235）,其中合并下肢DVT者4例.发生VTE时PM/DM病情多有活动和血浆D-二聚体的升高.结论 PM/DM患者存在发生VTE的风险,特别是年龄偏大患者,且可能多在PM/DM诊断后的早期发生,临床应提高认识,及早筛查并干预.

Objective To investigate the clinical characteristics of polymyositis/dermatomyositis （PM/DM） complicated with venous thromboembolism （VTE）.Methods Medical records of patients with PM/DM at Peking Union Medical College Hospital from Jan 2000 to Oct 2014 were reviewed to identify VTE.The comparisons of various categorical clinical manifestations between groups were evaluated using t-test and x2 test.Results Twenty-three PM/DM patients developed VTE,which accounted for 1.86% of the 1 235 PM/DM patients hospitalized during the same period.Among these 23 patients （18 female and 5 male）,5 patients had PM and 18 patients had DM.With respect to the occurrence of VTE,no significant difference was found between DM and PM or between male and female.Their age was （57±7） years （range：47-71 years old）,significantly older than patients without thrombosis [（47±13） years,t=-3.191,P=0.001].Twenty-one patients （75%,21/28） developed VTE in the first year after the diagnosis of PM/DM.The incidence rate ratios （IRR） for DVT in PM/DM were 1.46% （18/1 235） and for PTE was 0.73% （9/1 235）,in which 4 cases complicated with lower extremity DVT.Most patients exhibited active disease and high levels of D-Dimer during the emergence of VTE.Conclusion Patients with PM/DM have an increased risk of VTE,especially in older patients and at the early stage after the diagnosis of PM/DM,indicating that more attention should be paid to these patients in the clinic.