下肢深静脉血栓后综合征的危险因素分析

Risk factors of post-deep venous thrombosis syndrome in the lower extremities

目的探讨首诊下肢深静脉血栓(deep venous thrombosis,DVT)形成2年内发生血栓后综合征(post-thrombotic syndrome,PTS)的危险因素。方法回顾性分析2017年1月至2019年5月郑州大学第一附属医院血管外科首诊DVT患者的临床资料及2年随访数据,共260例。收集患者治疗及随访信息。根据Villalta评分分为无PTS组、轻度PTS组及中重度PTS组。采用有序多分类Logistic回归分析PTS形成的危险因素。结果患者轻度、中重度PTS发生率分别为22.7%和15.8%。DVT复发史(OR=4.754,95%CI 1.84~12.01,P=0.001)、口服抗凝药物时间≤6个月(0~3个月:OR=7.791,95%CI 1.79~33.90,P=0.006;4~6个月:OR=4.242,95%CI 1.13~15.99,P=0.033)、弹力袜穿戴时间≤12个月(0~6个月:OR=9.708,95%CI 1.81~52.14,P=0.008;7~12个月:OR=4.899,95%CI 1.42~16.88,P=0.012)及锻炼频率≤4次/周(1~2次/周:OR=7.691,95%CI 1.92~30.72,P=0.004;3~4次/周:OR=4.284,95%CI 1.33~13.80,P=0.015)是PTS发生的危险因素。静脉置管溶栓术(OR=0.436,95%CI 0.20~0.96,P=0.039)、低身体质量指数(BMI)<18.5 kg/m^(2)(OR=0.142,95%CI 0.02~0.81,P=0.028)、中央型血栓(OR=0.322,95%CI 0.15~0.72,P=0.005)和周围型血栓(OR=0.020,95%CI 0.01~0.07,P<0.001)是PTS发生的保护因素。结论DVT患者2年内形成PTS的风险高。静脉置管溶栓术、无DVT复发史、低BMI(<18.5 kg/m^(2))、中央型或周围型血栓、长期口服抗凝药物治疗(≥7个月)、更长的弹力袜穿戴时间(≥1年)及更高的锻炼频率(≥5~6次/周)有助于降低PTS的发生率、减轻PTS的程度。

Objective To investigate the risk factors associated with post-thrombotic syndrome(PTS)within 2 years after the first diagnosis of deep venous thrombosis(DVT)of the lower extremities.Methods The clinical data and 2-year follow-up data of 260 patients who were first diagnosed with DVT at our department from Jan 2017 to May 2019 were retrospectively analyzed.By Villalta score,the patients were divided into non-PTS group,mild PTS group and moderate-severe PTS group.Ordered multiple classification logistic regression was used to analyze the risk factors for the development of PTS.Results The incidence of mild and moderate-severe PTS was 22.7%and 15.8%,respectively.Multivariate Logistic regression analysis showed that recurrence history of DVT(OR=4.754,95%CI 1.84-12.01,P=0.001),duration of oral anticoagulation treatment≤6 months(0-3 months:OR=7.791,95%CI 1.79-33.90,P=0.006;4-6 months:OR=4.242,95%CI 1.13-15.99,P=0.033),time length of stretch sock wearing≤12 months(0-6 months:OR=9.708,95%CI 1.81-52.14,P=0.008;7-12 months:OR=4.899,95%CI 1.42-16.88,P=0.012)and exercise frequency≤4 times/week(1-2 times/week:OR=7.691,95%CI 1.92-30.72,P=0.004;3-4 times/week:OR=4.284,95%CI 1.33-13.80,P=0.015)were risk factors for PTS.Catheterized thrombolytic therapy(OR=0.436,95%CI 0.20-0.96,P=0.039)and low body mass index(BMI<18.5 kg/m^(2):OR=0.142,95%CI 0.02-0.81,P=0.028),central thrombus(OR=0.322,95%CI 0.15-0.72,P=0.005)and peripheral thrombus(OR=0.020,95%CI 0.01-0.07,P<0.001)were protective factors for PTS.Conclusions Patients with DVT have a high risk of developing PTS within 2 years.Catheter-directed thrombolysis,no history of recurrence of DVT,low BMI(<18.5 kg/m^(2)),central or peripheral thrombosis,long-term oral anticoagulant therapy(≥7 months),longer wearing time of elastic socks(≥1 year),and higher exercise frequency(≥5-6 times/week)can be conducive to the reduction of incidence and severity of PTS.