孤立性远端深静脉血栓的诊治现状

Diagnosis and Treatment of Isolated Distal Deep Vein Thrombosis

孤立性远端深静脉血栓(IDDVT)是一种常见的临床疾病,目前对该病的认识取得了一定的进展,但也存在不少争议。本文首先介绍了IDDVT在不同研究中观察到的颇具异质性的发病率,回顾了有关该病自然病程的研究,发现IDDVT仍然具有较低的进展为近端深静脉血栓(PDVT)和肺栓塞(PE)的风险。对比多种诊断方法后认为,血管加压超声(CUS)检查是IDDVT的最佳诊断方式,且对疑似IDDVT患者可选择动态近端CUS检查或全腿CUS检查,可有效监测IDDVT进展情况并指导临床治疗。综合IDDVT的治疗研究和国内外临床指南,目前建议对于高风险IDDVT患者,采用与PDVT/PE相同的抗凝治疗方案;而对于低风险IDDVT患者,则采用动态CUS检查。

Isolated distal deep vein thrombosis(IDDVT)is a common clinical disease.At present,some progress has been made in the understanding of the disease,but there are also many controversies.This review firstly describes the rather heterogeneous incidence of IDDVT observed in different studies,reviews studies on the natural history of the disease,and finds that IDDVT still has a low risk of progression to proximal deep vein thrombosis(PDVT)and pulmonary embolism(PE).After comparing various diagnostic methods,it is considered that compression ultrasonography(CUS)is the best diagnostic method of IDDVT,and dynamic proximal CUS or full leg CUS can be selected for patients with suspected IDDVT,which can effectively monitor the progress of IDDVT and guide clinical treatment.Based on the treatment research of IDDVT and clinical guidelines at home and abroad,it is currently recommended that for high-risk IDDVT patients,the same anticoagulation regimen as PDVT/PE should be used;for low-risk IDDVT patients,dynamic CUS examination should be used.