Vascular Medicine, Vimercate Hospital, Milan-Italy.
Thromb Res. 2010 Apr;125(4):315-7. doi: 10.1016/j.thromres.2009.06.023. Epub 2009 Jul 29.
Multiple sclerosis (MS) often causes progressive loss of mobility, leading to limb paralysis. Venous and lymphatic stasis is a risk condition for venous thromboembolism (VTE). There is, however, no data on the frequency of VTE complicating the progression of MS. The aim of this study was to assess the frequency of deep vein thrombosis (DVT) in patients with late-stage MS attending a neurology center for rehabilitation.
A total of 132 patients with MS were enrolled, 87 women and 45 men, mean age 58+/-11 years. The disease had started on average 18.7 years before; patients reported 9.6 hours bedridden per day or 14.3 hours wheelchair-bound. Only 25 patients reported a residual ability to walk alone or with help. Lower limb edema was present in 113 patients, bilateral in 41 cases. At admission all patients underwent extended compression ultrasonography. Their plasma D-dimer levels were measured. No antithrombotic prophylaxis was given.
DVT was found in 58 patients (43.9%); 32 had a history of VTE. Forty of these patients (69%) had chronic lower limb edema, in 19 cases bilateral. D-dimer levels in the DVT patients were significantly higher than in patients without DVT (553+/-678 vs. 261+/-152 ng/mL, p=0.0112, Mann-Whitney Test). Nearly half the DVT patients (26, 45%) had high D-dimer levels (701+/-684 ng/mL). Of the 74 patients without DVT, 48 had normal D-dimer (193.37+/-67.28 ng/mL) and 26 high (387.61+/-187.42 ng/mL).
The frequency of DVT in late-stage MS may be over 40%. The long history of the disease means the onset of each episode cannot be established with certainty. A number of patients with positive CUS findings had negative D-dimer values, suggesting a VTE event in the past. However, the level of DVT risk in this series should lead physicians to consider the systematic application of long-term preventive measures.
多发性硬化症（MS）常导致运动能力进行性丧失，导致肢体瘫痪。静脉和淋巴淤滞是静脉血栓栓塞（VTE）的风险状况。然而，目前尚无 MS 进展过程中并发 VTE 的频率数据。本研究旨在评估在神经病学中心接受康复治疗的晚期 MS 患者中深静脉血栓形成（DVT）的频率。
共纳入 132 例 MS 患者，其中 87 例为女性，45 例为男性，平均年龄 58+/-11 岁。疾病平均在 18.7 年前开始；患者报告每天卧床 9.6 小时或 14.3 小时轮椅。只有 25 例患者报告有单独或辅助行走的残留能力。113 例患者下肢水肿，41 例双侧。入院时所有患者均接受了扩展压缩超声检查。测量了他们的血浆 D-二聚体水平。未给予任何抗凝预防。
58 例（43.9%）患者发现 DVT；32 例有 VTE 病史。这些患者中有 40 例（69%）有慢性下肢水肿，19 例为双侧。DVT 患者的 D-二聚体水平明显高于无 DVT 患者（553+/-678 与 261+/-152 ng/mL，p=0.0112，Mann-Whitney 检验）。近一半的 DVT 患者（26 例，45%）D-二聚体水平较高（701+/-684 ng/mL）。在 74 例无 DVT 的患者中，48 例 D-二聚体正常（193.37+/-67.28 ng/mL），26 例升高（387.61+/-187.42 ng/mL）。
晚期 MS 中 DVT 的频率可能超过 40%。疾病的长病史意味着每次发作的发作时间不能确定。许多 CUS 检查阳性的患者 D-二聚体值为阴性，提示过去有 VTE 事件。然而，该系列中 DVT 风险水平应促使医生考虑系统应用长期预防措施。
