静脉血栓栓塞症合并抗磷脂抗体综合征8例临床分析

发布时间：2018-03-28 10:08

本文选题：静脉血栓栓塞症　切入点：抗磷脂抗体综合征　出处：《浙江大学》2017年硕士论文

【摘要】：目的:本文对8例静脉血栓栓塞症合并抗磷脂抗体综合征病例进行临床资料收集分析,总结其临床特点、实验室检查、影像学表现、治疗方案及预后随访情况。以期提高对抗磷脂抗体综合征的认识,改善静脉血栓栓塞症的预后,降低远期复发率。方法:收集2010年6月至2016年12月在浙江大学医学院附属邵逸夫医院住院诊治的静脉血栓栓塞症合并抗磷脂抗体综合征患者的资料。分析患者的发病特点、危险因素、实验室指标、超声心动图、下肢静脉彩超、CT肺动脉造影(computed tomographic pulmonary arteriography,CTPA)、治疗及预后随访等情况。结果:8例静脉血栓栓塞症合并抗磷脂抗体综合征临床表现主要为胸闷、胸痛、呼吸困难、咯血和下肢肿胀痛,均为静脉血栓栓塞症典型表现。其他临床特点包括血小板减少、活化部分凝血活酶时间APTT(activated partial thromboplastin time)延长、合并脑梗死和/或肾梗死、血栓复发。8例患者均选择低分子肝素、华法林/利伐沙班抗凝治疗,随访期间内未发生血栓复发。结论:静脉血栓栓塞的患者临床中若合并有不明原因的APTT延长、多发血栓形成、正规抗凝血栓复发或合并有反复流产既往史的建议行抗磷脂抗体的筛查,排除是否合并有抗磷脂抗体综合征可能。静脉血栓栓塞症合并抗磷脂抗体综合征的患者抗凝治疗,如无明显出血风险,建议予低分子肝素、华法林长期甚至终身抗凝,预防血栓复发。对于继发性抗磷脂抗体综合征患者除抗凝治疗外还需积极治疗原发病。
[Abstract]:Objective: to collect and analyze the clinical data of 8 patients with venous thromboembolism complicated with anti-phospholipid antibody syndrome, and to summarize the clinical features, laboratory examination and imaging findings. To improve the understanding of anti-phospholipid antibody syndrome and improve the prognosis of venous thromboembolism. Methods: from June 2010 to December 2016, the data of patients with venous thromboembolism complicated with anti-phospholipid antibody syndrome were collected and analyzed. Risk factors, laboratory parameters, echocardiography, CT pulmonary angiography of lower extremity venous color Doppler ultrasound and tomographic pulmonary arteriography, treatment and prognosis were followed up. Results the clinical manifestations of 8 cases of venous thromboembolism with anti-phospholipid antibody syndrome were mainly chest tightness. Chest pain, dyspnea, hemoptysis and swelling pain of lower extremity are typical manifestations of venous thromboembolism. Other clinical features include thrombocytopenia, prolonged activated partial thromboplastin time (APTT(activated partial thromboplastin time), cerebral infarction and / or renal infarction. Low molecular weight heparin (LMWH) and warfarin / rivastaben were used in all patients with thrombotic recurrence. No thrombus recurrence occurred during the follow-up period. Conclusion: in patients with venous thromboembolism, APTT prolongation with unknown cause was found in the patients with venous thromboembolism. Multiple thrombus formation, recurrence of regular anticoagulant thrombus or previous history of recurrent abortion are recommended for screening for anti-phospholipid antibodies. Anticoagulant therapy for patients with venous thromboembolism associated with anti-phospholipid antibody syndrome is recommended for low molecular weight heparin (LMWH), warfarin for long term or even lifetime anticoagulation if there is no significant risk of bleeding. Prevention of thrombus recurrence. In addition to anticoagulant therapy, the patients with secondary anti-phospholipid antibody syndrome should be actively treated with primary diseases.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.2;R543.6

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