库欣综合征高凝状态与静脉血栓栓塞风险

Hypercoagulable state and risk of venous thromboembolism in Cushing syndrome

库欣综合征(Cushing syndrome,CS)是以高皮质醇血症为特征的内分泌代谢疾病,高皮质醇血症可诱发高凝状态,导致静脉血栓栓塞(venous thromboembolism,VTE)风险增加。无论是垂体来源的库欣病(Cushing disease,CD),还是肾上腺来源的非促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)依赖性CS,手术均是一线治疗选择。在手术和疾病本身的双重影响下,VTE风险进一步增加,甚至导致肺栓塞,严重威胁患者生命安全。此外,高凝状态的CS患者的心血管病和VTE发生率乃至病死率均高于正常人群,未经治疗的活动性CS患者的VTE发生率较普通人群升高了17.8倍。近年来,CS高凝状态与VTE之间的关系引起了越来越多临床医师的重视。进一步了解CS高凝状态的临床流行病学特点、病理生理机制和VTE及肺栓塞的临床防治,可以为CS患者预防性抗凝药物规范化使用提供参考。

Cushing syndrome(CS)is an endocrine-metabolic disorder characterized by hypercortisolism.Elevated cortisol levels can induce a hypercoagulable state,increasing the risk of venous thromboembolism(VTE).Both pituitary-origin Cushing disease(CD)and adrenal-origin non-adrenocorticotropic hormone(ACTH)-dependent CS are primarily treated with surgery.The dual impact of surgery and the underlying disease further elevates the risk of VTE,potentially leading to pulmonary embolism,which poses a severe threat to patient survival.Additionally,CS patients in a hypercoagulable state have a higher incidence of cardiovascular diseases and VTE,and even mortality compared with the general population.Untreated active CS patients have a 17.8-fold increased risk of VTE compared to the general population.In recent years,the relationship between the hypercoagulable state in CS and VTE has garnered increasing attention from clinicians.A better understanding of the clinical epidemiological characteristics,pathophysiological mechanisms,and clinical prevention and treatment of VTE and pulmonary embolism in CS can provide valuable references for the standardized use of prophylactic anticoagulant therapy in CS patients.