MacKenzie R K, Brown D A, Allan P L, Bradbury A W, Ruckley C V
Vascular Surgery Unit, Royal Infirmary, Edinburgh, Scotland, UK.
Eur J Vasc Endovasc Surg. 2003 Aug;26(2):176-8. doi: 10.1053/ejvs.2002.1954.
although chronic venous ulceration (CVU) is often viewed primarily as a disease of the elderly, recent epidemiological data suggest that a significant proportion of patients first develop CVU before middle age. Such patients may represent a distinct group in terms of aetiology, natural history, prognosis and therapeutic options.
to compare patients who developed CVU before (Group 1) and after (Group 2) their 50th birthday.
one hundred and eighteen consecutive patients with "pure" CVU underwent history and examination, measurement of ankle-brachial pressure index (ABPI) and duplex ultrasound examination of the affected limb. Pure venous ulcers were defined as those of >4 weeks duration in the presence of venous reflux (>0.5) and in association with an ankle: brachial pressure index of >0.8.
patients in Group 1 (n = 54, 46%) were more likely to be male (32/54 [59%] vs 14/64 [23%], p < 0.001 chi(2)), to have a higher median (interquartile [IQR]) body mass index (32 [27-39] vs 27 [23-34], p = 0.003, Mann-Whitney U [MWU]), to have a history of deep venous thrombosis (23/54 [43%] vs 16/64 [25%], p = 0.04 chi(2)) and of ipsilateral long bone fracture (13/54 [24%] vs 5/64 [8%], p = 0.01, chi(2)), to have previously undergone venous surgery (27/54 [50%] vs 19/64 [30%] a median (IQR) of 11.5 (6.5-19) and 10 (2-20) years earlier respectively, and to have worse disease in terms of the duration of present ulcer (12 (6-36) vs 8.5 [3-18] months, p = 0.035 MWU), the total duration of ulcer disease (216 [72-360] vs 48 [12-120] months, p < 0.001 MWU), and the number of episodes of ulceration (3 [2-7] vs 1 [1-3], p = 0.002 MWU). There was no significant difference between the two groups in the pattern and severity of venous reflux with 46/54 (85%) of Group 1 and 54/64 (84%) of Group 2 patients having surgically correctable superficial venous reflux.
patients who develop CVU before their 50th birthday appear to represent a distinct group in terms of aetiology, natural history and prognosis. The importance of thrombo-embolic prophylaxis in the prevention, and the detection and correction of superficial venous reflux in the treatment, of such ulcers is re-emphasised.
尽管慢性静脉溃疡（CVU）通常主要被视为一种老年疾病，但最近的流行病学数据表明，相当一部分患者在中年之前首次发生CVU。就病因、自然病史、预后和治疗选择而言，这类患者可能代表一个独特的群体。
比较50岁之前（第1组）和之后（第2组）发生CVU的患者。
118例连续的“单纯性”CVU患者接受了病史询问和体格检查、踝肱压力指数（ABPI）测量以及患侧肢体的双功超声检查。单纯性静脉溃疡定义为病程超过4周，存在静脉反流（>0.5）且踝肱压力指数>0.8。
第1组（n = 54，46%）患者更可能为男性（32/54 [59%] 对比14/64 [23%]，p < 0.001，卡方检验），具有更高的中位数（四分位间距 [IQR]）体重指数（32 [27 - 39] 对比27 [23 - 34]，p = 0.003，曼-惠特尼U检验 [MWU]），有深静脉血栓形成病史（23/54 [43%] 对比16/64 [25%]，p = 0.04，卡方检验）和同侧长骨骨折病史（13/54 [24%] 对比5/64 [8%]，p = 0.01，卡方检验），先前接受过静脉手术（27/54 [50%] 对比19/64 [30%]，分别于中位数（IQR）为11.5（6.5 - 19）年和10（2 - 20）年前进行），并且就当前溃疡持续时间（12 [6 - 36] 对比8.5 [3 - 18] 个月，p = 0.035，MWU）、溃疡疾病总持续时间（216 [72 - 360] 对比48 [12 - 120] 个月，p < 0.001，MWU）以及溃疡发作次数（3 [2 - 7] 对比1 [1 - 3]，p = 0.002，MWU）而言，疾病情况更差。两组在静脉反流的模式和严重程度方面无显著差异，第1组46/54（85%）和第2组54/64（84%）的患者存在可通过手术纠正的浅静脉反流。
50岁之前发生CVU的患者在病因、自然病史和预后方面似乎代表一个独特的群体。再次强调了血栓栓塞预防在这类溃疡预防中的重要性，以及浅静脉反流的检测和纠正在治疗中的重要性。
