Li Han, Wang Shi-Xiang, Wang Wei, Xu Chen, Shen Shen, Yu Ling, Zhang Gui-Zhi
Blood Purification Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Chin Med J (Engl). 2009 Mar 20;122(6):692-6.
Central venous thrombosis is a serious and life-threatening complication in hemodialysis (HD) patients with an indwelling catheter. The present study aimed to investigate the prevalence and characteristics of thrombosis of the superior vena cava and auxiliary branches in Chinese HD patients with an indwelling internal jugular venous catheter and to explore its risk factors.
Fifty-four patients on maintenance hemodialysis (MHD) with an indwelling catheter were enrolled in this cross-sectional study. The thrombosis of the internal jugular vein, subclavical vein, brachiocephalic vein and superior vena cava was assessed by vascular ultrasound. Collected were data on age, gender, ultrafiltration volume, Kt/V, blood pressure, levels of hemoglobin, serum albumin, lipid, calcium, and phosphorus, and parathyroid hormone.
The patients were given short- or long-term double lumen central venous catheters. Among them, 42 patients had the catheter placed into the right internal jugular vein, and 12 patients into the left internal jugular vein. Different degrees of central venous thrombosis were found in 33 patients (61.1%). The prevalence of thrombosis in the jugular vein, brachiocephalic vein, subclavical vein and superior vena cava was 61.1% (33/54), 44.4% (24/54), 16.7% (9/54) and 5.6% (3/54), respectively. Among the 33 HD patients with central venous thrombosis, the percentages for one, two, three and four affected veins were 27.3% (9/33), 45.4% (15/33), 18.2% (6/33) and 9.1% (3/33), respectively. Twelve (12/33, 36.4%) of the 33 HD patients with central venous thrombosis had clinical symptoms. Nine patients (27.3%) had edema of the upper extremity and 3 (9.1%) had new-onset symptoms of pulmonary embolism such as cough, chest distress and short breath. The incidences of diabetes mellitus and malignant tumor and levels of lipoprotein a and homocysteic acid were significantly higher in the HD patients with central venous thrombosis than in those without central venous thrombosis. Logistic regressive analysis revealed that high level of homocysteic acid was the important risk factor for central venous thrombosis in HD patients with indwelling catheterization of the internal jugular vein.
The prevalence of central venous thrombosis in Chinese HD patients with indwelling catheterization of the internal jugular vein is quite high, especially in those patients with diabetes mellitus, malignant tumor, high levels of serum lipoprotein and homocysteic acid. Its clinical symptoms are insidious but dangerous. High level of homocysteic acid may be the important risk factor for central venous thrombosis in Chinese HD patients with indwelling catheterization of the internal jugular vein.
中心静脉血栓形成是血液透析（HD）留置导管患者严重且危及生命的并发症。本研究旨在调查中国HD留置颈内静脉导管患者上腔静脉及其分支血栓形成的患病率和特征，并探讨其危险因素。
本横断面研究纳入了54例维持性血液透析（MHD）且留置导管的患者。通过血管超声评估颈内静脉、锁骨下静脉、头臂静脉和上腔静脉的血栓形成情况。收集了患者的年龄、性别、超滤量、Kt/V、血压、血红蛋白、血清白蛋白、血脂、钙、磷水平以及甲状旁腺激素等数据。
患者使用了短期或长期双腔中心静脉导管。其中，42例患者的导管置于右侧颈内静脉，12例患者的导管置于左侧颈内静脉。33例患者（61.1%）发现不同程度的中心静脉血栓形成。颈静脉、头臂静脉、锁骨下静脉和上腔静脉血栓形成的患病率分别为61.1%（33/54）、44.4%（24/54）、16.7%（9/54）和5.6%（3/54）。在33例发生中心静脉血栓形成的HD患者中，累及1条、2条、3条和4条静脉的比例分别为27.3%（9/33）、45.4%（15/33）、18.2%（6/33）和9.1%（3/33）。33例发生中心静脉血栓形成的HD患者中，12例（12/33，36.4%）有临床症状。9例患者（27.3%）出现上肢水肿，3例（9.1%）出现新发肺栓塞症状，如咳嗽、胸闷和气短。中心静脉血栓形成的HD患者中糖尿病、恶性肿瘤的发生率以及脂蛋白a和同型半胱氨酸水平显著高于无中心静脉血栓形成的患者。Logistic回归分析显示，高同型半胱氨酸水平是颈内静脉留置导管的HD患者中心静脉血栓形成的重要危险因素。
中国HD留置颈内静脉导管患者中心静脉血栓形成的患病率相当高，尤其是糖尿病、恶性肿瘤、血清脂蛋白和同型半胱氨酸水平高的患者。其临床症状隐匿但危险。高同型半胱氨酸水平可能是中国HD留置颈内静脉导管患者中心静脉血栓形成的重要危险因素。
