Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan.
J Thromb Haemost. 2009 Sep;7(9):1506-13. doi: 10.1111/j.1538-7836.2009.03528.x. Epub 2009 Jun 23.
The risk factors that affect the development of post-thrombotic syndrome (PTS) are not fully recognized, and it is difficult to reliably predict which patients are likely to develop PTS in acute phase of deep vein thrombosis (DVT).
To investigate changes in calf muscle deoxygenated hemoglobin (HHb) levels after DVT, and to determine the indicative parameters reflecting the progression of PTS.
Seventy-six consecutive patients with a first episode of unilateral DVT were prospectively enrolled. Clinical manifestations were categorized according to the CEAP (Clinical, Etiologic, Anatomical, and Pathophysiologic) classification, and the patients were divided into no-PTS (C(0-3)E(s),A(s,d,p),P(r,o)) and PTS (C(4-6)E(s),A(s,d,p),P(r,o)) groups. Near-infrared spectroscopy (NIRS) was used to measure calf muscle HHb levels at 6 months after diagnosis of DVT. The calf venous blood filling index (HHbFI) was calculated on standing, and the venous ejection index and the venous retention index (HHbRI) were then obtained after exercise. All patients were followed up for more than 24 months after the diagnosis of DVT.
Of 76 patients evaluated, 20 (26.3%) had PTS. The NIRS-derived HHbFI and HHbRI were significantly increased in patients who developed PTS in comparison with those who did not (P = 0.04 and P = 0.0001, respectively). HHbRI was significantly increased in patients with iliofemoral DVT in comparison with patients with calf DVT (P = 0.041). An optimal cut-off point of 2.9 for HHbRI showed the strongest ability to predict the development of PTS, with a sensitivity of 100% and a specificity of 82.1%.
HHbRI as measured by NIRS is significantly increased in patients with iliofemoral DVT as compared with those with calf DVT. Furthermore, HHbRI > 2.9 is a strong predictor of the development of PTS at 6 months.
影响血栓后综合征（PTS）发展的危险因素尚不完全清楚，难以可靠地预测哪些患者在深静脉血栓形成（DVT）急性期可能发生 PTS。
研究 DVT 后腓肠肌去氧血红蛋白（HHb）水平的变化，并确定反映 PTS 进展的指示参数。
前瞻性纳入 76 例首次单侧 DVT 患者。根据 CEAP（临床、病因、解剖和病理生理）分类对临床表现进行分类，将患者分为无 PTS（C（0-3）E（s）、A（s、d、p）、P（r、o））和 PTS（C（4-6）E（s）、A（s、d、p）、P（r、o））组。在 DVT 诊断后 6 个月，使用近红外光谱（NIRS）测量腓肠肌 HHb 水平。在站立时计算小腿静脉血液充盈指数（HHbFI），然后在运动后获得静脉射血指数和静脉保留指数（HHbRI）。所有患者在 DVT 诊断后均随访超过 24 个月。
在 76 例患者中，有 20 例（26.3%）患有 PTS。与未发生 PTS 的患者相比，发生 PTS 的患者的 NIRS 衍生 HHbFI 和 HHbRI 显着增加（P=0.04 和 P=0.0001）。与小腿 DVT 患者相比，髂股 DVT 患者的 HHbRI 显着增加（P=0.041）。HHbRI 的最佳截断值为 2.9，对 PTS 发生的预测能力最强，灵敏度为 100%，特异性为 82.1%。
与小腿 DVT 患者相比，NIRS 测量的 HHbRI 在髂股 DVT 患者中显着增加。此外，HHbRI＞2.9 是 6 个月时 PTS 发生的强预测因子。
