肝硬化合并静脉血栓栓塞症的临床诊治

The clinical features of venous thromboembolism in patients with cirrhosis

目的:探讨肝硬化合并静脉血栓栓塞症(venous thromboembolism,VTE)的临床特征及诊治要点。方法:回顾分析复旦大学附属中山医院2004年1月至2015年12月期间收住入院的23例VTE合并肝硬化患者的临床特征及治疗预后。结果:观察期内VTE合并肝硬化患者的发生率为0.8%。23例患者中男性16例,女性7例,年龄43~84岁,平均(55.7±10.1)岁。肝硬化A级患者(n=9)血清蛋白及血红蛋白含量高于肝硬化B级、C级患者(n=14),差异有统计学意义(P<0.05);A级患者凝血功能和血肌酐水平优于B级、C级患者,其D-二聚体水平及血小板含量略低于B级、C级患者,但两组间各项指标差异无统计学意义。73.9%的患者也有恶性肿瘤病史。18例患者接受低分子肝素治疗;5例患者未接受抗凝治疗,其中3例死亡。结论:肝硬化患者也有静脉血栓形成风险,需要早期诊断,及时治疗。

Objective：To explore the clinical features and key points in treatment and diagnosis of venous thromboembolism （VTE）combined cirrhosis.Methods：Clinical data of 23 patients with venous thromboembolism combined cirrhosis were analyzed retrospectively.Results：The incidence rate of VTE combined cirrhosis was 0 .8%.Sixteen males and seven females were enrolled in this study,aged from 43 to 84 years old with an average age of （55.7±10.1）years old.The levels of blood albumin and hemoglobin of A level liver cirrhosis patients （n= 9 ）were obviously higher than B level and C level liver cirrhosis patients （n= 14,P〈0.05）.The blood coagulation and serum creatinine in A level patients were better than B level and C level patients,and the D dimer and blood platelet was slightly lower than B level and C level patients,but no statistical significance was found between two groups.There were 73.9% patients had malignant tumor history.Eighteen patients received low molecular weight heparin for treatment.Five patients did not receive any anticoagulation therapy,and three of them died during hospitalization.Conclusions：The physicians should pay attention to the risk of the cirrhotic patients with VTE developing,and its need for early diagnosis and timely treatment.