Mesenteric venous thrombosis(MVT)is a rare but life threatening form of bowel ischemia.It is implicated in 6%-9% of all cases of acute mesenteric ischemia.The proportion of patients with primary(or idiopathic)MVT vari...Mesenteric venous thrombosis(MVT)is a rare but life threatening form of bowel ischemia.It is implicated in 6%-9% of all cases of acute mesenteric ischemia.The proportion of patients with primary(or idiopathic)MVT varies from 0% to 49%,with a decrease in frequency secondary to more recent availability of newer investigations for hypercoagulability.The presence of factor Ⅴ Leiden(FVL)and prothrombin G20210A mutations(PGM)have been well documented in these cases.However,there have been scarce case reports describing MVT in heterozygotes of both these mutations occurring simultaneously and its implications on long term management.Our case describes acute MVT in a previously asymptomatic young patient with no prior history of venous thromboembolism.The patient was found to be heterozygous for FVL and PGM and treated with lifelong anticoagulation with warfarin(goal international normalized ratio:2-3)and avoidance of hormonal contraceptives.展开更多
Ehlers-Danlos syndrome(EDS) is a group of inherited connective tissue disorders caused by collagen synthesis defects. Several hemostatic abnormalities have been described in EDS patients that increase the bleeding ten...Ehlers-Danlos syndrome(EDS) is a group of inherited connective tissue disorders caused by collagen synthesis defects. Several hemostatic abnormalities have been described in EDS patients that increase the bleeding tendencies of these patients. This case report illustrates a patient with an unusual presentation of a patient with type Ⅳ EDS, platelet δ-storage pool disease and factor Ⅴ Leiden mutation. Young woman having previous bilateral deep vein thrombosis and pulmonary emboli coexisting with ruptured splenic aneurysm and multiple other aneurysms now presented with myocardial infarction. Presence of factor Ⅴ Leiden mutation raises the possibility that the infarct was due to acute coronary thrombosis, although coronary artery aneurysm and dissection with myocardial infarction is known to occur in vascular type EDS. This is the first report in the medical literature of factor Ⅴ Leiden mutation in an EDS patient which made the management of our patient challenging with propensity to both bleeding and clotting.展开更多
To explore the relationship between genetic variation in coagulation factor Ⅴ and the occurrence of coronary arterial disease (CAD) Methods Unrelated 86 patients with CAD and 102 healthy controls were analyzed by ...To explore the relationship between genetic variation in coagulation factor Ⅴ and the occurrence of coronary arterial disease (CAD) Methods Unrelated 86 patients with CAD and 102 healthy controls were analyzed by polymerase chain reaction denaturing gradient gel electrophoresis (PCR DGGE) to detect variations in the entire twenty five exons of the factor Ⅴ gene Results Polymorphisms in exon 4 [642 GT (Ser156)], exon 10 [1628 GA (Arg485Lys)], exon 13 [4070 AG (His1299Arg)] and exon 16 [5380 GA (Val1736Met)] were documented The study also identified a novel polymorphism in exon 2 (327 AG) which did not result in amino acid residue substitution The Leiden mutation (Arg506Gln) was not detected in any of our 188 subjects Among the 5 polymorphisms, the allele frequency of 1628 GA was significantly different between CAD patients and controls (0 69 vs 0 81, χ 2=6 908, P <0 01) This is the first report of this finding in a Chinese population Conclusion 1628 GA polymorphism is associated with CAD and it may be a risk factor for CAD morbidity in the Chinese population展开更多
目的:研究肿瘤诱发的获得性凝血因子Ⅴ缺乏症(acquired factor V deficiency, AFVD)临床表现特点,探讨肿瘤诱发的AFVD的治疗选择。方法:报道1例肿瘤诱发AFVD患者的临床特征、实验室检查指标、诊治经过并进行相关的文献复习及讨论。结果...目的:研究肿瘤诱发的获得性凝血因子Ⅴ缺乏症(acquired factor V deficiency, AFVD)临床表现特点,探讨肿瘤诱发的AFVD的治疗选择。方法:报道1例肿瘤诱发AFVD患者的临床特征、实验室检查指标、诊治经过并进行相关的文献复习及讨论。结果:老年男性,临床表现为黑便,无遗传性凝血因子缺乏病史及家族史。实验室检查提示凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)显著延长,凝血因子V活性(Factor V∶C)降低,Ⅴ因子抑制物水平升高。PET/CT:结肠及回肠末段代谢增高,提示肿瘤性疾病。对症输注新鲜冰冻血浆(FFP)后疗效欠佳。应用糖皮质激素治疗后出现血压明显升高,继而出现急性硬膜下出血,紧急给予Ⅶ因子抢救,最终放弃治疗出院,院外患者死亡。结论:获得性凝血因子Ⅴ抑制物所致的凝血障碍是一种少见疾病,预后与患者基础疾病相关。对于老年患者需注意除外肿瘤性疾病继发的AFVD以及糖皮质激素治疗的副作用。展开更多
Thromboembolism is a significant cause of morbidity and mortality in patients with inflammatory bowel dis-ease (IBD). Recent data suggest thromboembolism as a disease-specific extraintestinal manifestation of IBD, whi...Thromboembolism is a significant cause of morbidity and mortality in patients with inflammatory bowel dis-ease (IBD). Recent data suggest thromboembolism as a disease-specific extraintestinal manifestation of IBD, which is developed as the result of multiple interac- tions between acquired and genetic risk factors. There is evidence indicating an imbalance of procoagulant, anticoagulant and fibrinolitic factors predisposing in thrombosis in patients with IBD. The genetic factors that have been suggested to interfere in the thrombotic manifestations of IBD include factor Leiden, factor (prothrombin, G20210A), methylenetetrahydrofolate reductase gene mutation (MTHFR, 6777T), plasminogen activator inhibitor type 1 (PAI-1) gene mutation and fac- tor (val34leu). In this article we review the current data and future prospects on the role of genetic risk factors in the development of thromboembolism in IBD.展开更多
目的:通过检测复合杂合突变导致遗传性凝血因子Ⅴ(FⅤ)缺陷家系的表型和基因突变分析,探讨其分子发病机制。方法:检测先证者及其家系成员(共3代10人)血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、FⅤ促凝活性(...目的:通过检测复合杂合突变导致遗传性凝血因子Ⅴ(FⅤ)缺陷家系的表型和基因突变分析,探讨其分子发病机制。方法:检测先证者及其家系成员(共3代10人)血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、FⅤ促凝活性(FⅤ∶C)、FⅤ抗原(FⅤ∶Ag)及其他相关凝血指标以明确诊断。采用DNA直接测序分析F5基因的所有外显子、侧翼、5'和3'非翻译区及家系成员相应的突变位点区域,发现突变位点用反向测序证实。使用ClustalX-2.1-win软件分析突变氨基酸的保守性,PROVEAN和MutationTaster在线生物信息学软件预测突变对蛋白质功能的影响,Swiss-PdbViewer软件在突变位点上进行蛋白质模型和氨基酸相互作用分析。结果:先证者PT和APTT较正常对照健康体检者显著延长,分别为34.2 vs 13.2 s和119.3 vs 36.0 s;FⅤ∶C和FⅤ∶Ag极度降低,分别为3%和6%。先证者的第二子、第三子、女儿和孙子的PT和APTT略有延长,FⅤ∶C和FⅤ∶Ag均有不同程度的降低,其他家庭成员的相关凝血参数均在正常范围内。先证者6号外显子上存在c.911G>A杂合错义突变,导致p.Gly276Glu;16号外显子上存在c.5343C>G杂合错义突变,导致p.Ser1781Arg。其第二子、第三子和孙子均携带p.Gly276Glu的杂合子,其女儿携带p.Ser1781Arg的杂合子,其他家庭成员均为野生型。保守分析结果表明,Gly276和Ser1781在同源物种中高度保守。2种生物信息学软件的预测结果相同,PROVEAN(得分-6.214和-12.79)表明,该复合杂合突变是一种有害突变;MutationTaster(得分0.976和0.999)提示,这些突变可能引起相应疾病。p.Gly276Glu蛋白质模型分析显示,Glu侧链延长,分子量变大,这将增加它与周围氨基酸之间的空间位阻,影响FⅤ蛋白的正常局部折叠,最终导致蛋白质活性和含量降低。由于尚无16号外显子FⅤ的X射线3D结构文件,本研究无法对p.Ser1781Arg突变蛋白进行空间结构分析。结论:在本研究中鉴定的新型复合杂合突变(p.Gly276Glu和p.Ser1781Arg)是该家系FⅤ水平下降的主要原因,其中p.Ser1781Arg国内外鲜见报道。展开更多
文摘Mesenteric venous thrombosis(MVT)is a rare but life threatening form of bowel ischemia.It is implicated in 6%-9% of all cases of acute mesenteric ischemia.The proportion of patients with primary(or idiopathic)MVT varies from 0% to 49%,with a decrease in frequency secondary to more recent availability of newer investigations for hypercoagulability.The presence of factor Ⅴ Leiden(FVL)and prothrombin G20210A mutations(PGM)have been well documented in these cases.However,there have been scarce case reports describing MVT in heterozygotes of both these mutations occurring simultaneously and its implications on long term management.Our case describes acute MVT in a previously asymptomatic young patient with no prior history of venous thromboembolism.The patient was found to be heterozygous for FVL and PGM and treated with lifelong anticoagulation with warfarin(goal international normalized ratio:2-3)and avoidance of hormonal contraceptives.
文摘Ehlers-Danlos syndrome(EDS) is a group of inherited connective tissue disorders caused by collagen synthesis defects. Several hemostatic abnormalities have been described in EDS patients that increase the bleeding tendencies of these patients. This case report illustrates a patient with an unusual presentation of a patient with type Ⅳ EDS, platelet δ-storage pool disease and factor Ⅴ Leiden mutation. Young woman having previous bilateral deep vein thrombosis and pulmonary emboli coexisting with ruptured splenic aneurysm and multiple other aneurysms now presented with myocardial infarction. Presence of factor Ⅴ Leiden mutation raises the possibility that the infarct was due to acute coronary thrombosis, although coronary artery aneurysm and dissection with myocardial infarction is known to occur in vascular type EDS. This is the first report in the medical literature of factor Ⅴ Leiden mutation in an EDS patient which made the management of our patient challenging with propensity to both bleeding and clotting.
基金ThisstudywassupportedbytheScientificandTechnologicalCommitteeofShanghai (No 9741 1 90 0 3)
文摘To explore the relationship between genetic variation in coagulation factor Ⅴ and the occurrence of coronary arterial disease (CAD) Methods Unrelated 86 patients with CAD and 102 healthy controls were analyzed by polymerase chain reaction denaturing gradient gel electrophoresis (PCR DGGE) to detect variations in the entire twenty five exons of the factor Ⅴ gene Results Polymorphisms in exon 4 [642 GT (Ser156)], exon 10 [1628 GA (Arg485Lys)], exon 13 [4070 AG (His1299Arg)] and exon 16 [5380 GA (Val1736Met)] were documented The study also identified a novel polymorphism in exon 2 (327 AG) which did not result in amino acid residue substitution The Leiden mutation (Arg506Gln) was not detected in any of our 188 subjects Among the 5 polymorphisms, the allele frequency of 1628 GA was significantly different between CAD patients and controls (0 69 vs 0 81, χ 2=6 908, P <0 01) This is the first report of this finding in a Chinese population Conclusion 1628 GA polymorphism is associated with CAD and it may be a risk factor for CAD morbidity in the Chinese population
文摘目的 :探讨国人布 -加综合征 (BCS)与凝血第 因子 L eiden(F L)突变的相关性。方法 :收集 2 9例国人BCS(其中 2 5例为散发 BCS、4例为家族性 BCS)和 2 9名健康对照者 ,并对其血样进行 PCR- RFL P的 F L 突变分析。结果 :2 9例 BCS中 ,共有 3例 F L 突变阳性 ,均为家族性 BCS病例。其中家系 A姐妹均有 F L 突变 ,家系 B妹妹突变阳性 ,均为杂合性突变。散发病例无 1例阳性。对照组无 1例阳性。 2 9例国人 BCS中 ,F L 突变频率为0 .0 5 17,而 4例家族性 BCS的 F L 突变频率则为 0 .375 0。2 9例 BCS病例组与 2 9例对照组间 F L 突变频率无统计学差别 ,但家族性 BCS病例组与对照组间 F L 突变频率有显著统计学差别。结论 :国人家族性 BCS与 F L 突变相关 ,国人散发性 BCS与 F L
文摘Thromboembolism is a significant cause of morbidity and mortality in patients with inflammatory bowel dis-ease (IBD). Recent data suggest thromboembolism as a disease-specific extraintestinal manifestation of IBD, which is developed as the result of multiple interac- tions between acquired and genetic risk factors. There is evidence indicating an imbalance of procoagulant, anticoagulant and fibrinolitic factors predisposing in thrombosis in patients with IBD. The genetic factors that have been suggested to interfere in the thrombotic manifestations of IBD include factor Leiden, factor (prothrombin, G20210A), methylenetetrahydrofolate reductase gene mutation (MTHFR, 6777T), plasminogen activator inhibitor type 1 (PAI-1) gene mutation and fac- tor (val34leu). In this article we review the current data and future prospects on the role of genetic risk factors in the development of thromboembolism in IBD.
文摘目的:通过检测复合杂合突变导致遗传性凝血因子Ⅴ(FⅤ)缺陷家系的表型和基因突变分析,探讨其分子发病机制。方法:检测先证者及其家系成员(共3代10人)血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、FⅤ促凝活性(FⅤ∶C)、FⅤ抗原(FⅤ∶Ag)及其他相关凝血指标以明确诊断。采用DNA直接测序分析F5基因的所有外显子、侧翼、5'和3'非翻译区及家系成员相应的突变位点区域,发现突变位点用反向测序证实。使用ClustalX-2.1-win软件分析突变氨基酸的保守性,PROVEAN和MutationTaster在线生物信息学软件预测突变对蛋白质功能的影响,Swiss-PdbViewer软件在突变位点上进行蛋白质模型和氨基酸相互作用分析。结果:先证者PT和APTT较正常对照健康体检者显著延长,分别为34.2 vs 13.2 s和119.3 vs 36.0 s;FⅤ∶C和FⅤ∶Ag极度降低,分别为3%和6%。先证者的第二子、第三子、女儿和孙子的PT和APTT略有延长,FⅤ∶C和FⅤ∶Ag均有不同程度的降低,其他家庭成员的相关凝血参数均在正常范围内。先证者6号外显子上存在c.911G>A杂合错义突变,导致p.Gly276Glu;16号外显子上存在c.5343C>G杂合错义突变,导致p.Ser1781Arg。其第二子、第三子和孙子均携带p.Gly276Glu的杂合子,其女儿携带p.Ser1781Arg的杂合子,其他家庭成员均为野生型。保守分析结果表明,Gly276和Ser1781在同源物种中高度保守。2种生物信息学软件的预测结果相同,PROVEAN(得分-6.214和-12.79)表明,该复合杂合突变是一种有害突变;MutationTaster(得分0.976和0.999)提示,这些突变可能引起相应疾病。p.Gly276Glu蛋白质模型分析显示,Glu侧链延长,分子量变大,这将增加它与周围氨基酸之间的空间位阻,影响FⅤ蛋白的正常局部折叠,最终导致蛋白质活性和含量降低。由于尚无16号外显子FⅤ的X射线3D结构文件,本研究无法对p.Ser1781Arg突变蛋白进行空间结构分析。结论:在本研究中鉴定的新型复合杂合突变(p.Gly276Glu和p.Ser1781Arg)是该家系FⅤ水平下降的主要原因,其中p.Ser1781Arg国内外鲜见报道。
