Department of Vascular Surgery, St. Josef Hospital, Bochum, Germany.
Eur J Vasc Endovasc Surg. 2010 Jul;40(1):117-21. doi: 10.1016/j.ejvs.2010.01.023. Epub 2010 Mar 3.
To assess the difference in the oestradiol levels of blood taken from varicose veins in patients with and without pelvic vein incompetence (PVI).
Women of child-bearing age with symptomatic primary or recurrent varicose veins of the great saphenous vein (GSV) were included in a prospective study. Patients underwent duplex ultrasonography and pelvic vein phlebography. They were divided into a group with PVI (PVI group) and a control group with GSV reflux alone (VV group). Blood samples were collected from the GSV at the sapheno-femoral junction or lower in the thigh as well as from the arm. Oestradiol levels were determined by electroluminescence.
Between January and December 2007, 40 women were studied, of which 19 showed phlebographic evidence of PVI (PVI group), while 21 were included in the VV group. Phlebography revealed an incompetent ovarian vein in 14 (74%) patients of the PVI group, dilated uterine and ovarian plexuses in 12 (63%) and an incompetent internal iliac vein in six cases (32%). In the PVI group, the median oestradiol level in GSV samples was 121 pgml(-1) (range: 12-4300), while in the VV group the median level was 75 pgml(-1) (range: 9-1177). In the upper limb, the PVI group patients had a median level of 78 pgml(-1) (range: 15-121) and the VV group patients 68 pgml(-1) (range: 13-568). The ratio of lower limb/upper extremity was significantly higher (p<0.002) in patients of PVI group (median: 1.9; range: 0.7-33) than in those of the VV group (median: 1.1; range: 0.8-13). A threshold ratio of 1.4 showed the highest combined sensitivity and specificity in differentiating patients with PVI from those without.
In patients with varicose veins arising from the GSV, oestradiol levels were significantly higher in the lower limb than in the upper extremity in the subgroup with associated PVI. It may be possible to use this observation as a diagnostic test in patients with suspected PVI. This deserves further study.
评估伴有和不伴有盆腔静脉功能不全（PVI）的静脉曲张患者静脉血中雌二醇水平的差异。
本前瞻性研究纳入了年龄在生育期的、有症状的原发性或复发性大隐静脉曲张（GSV）的女性患者。所有患者均行双功能超声和盆腔静脉造影。根据造影结果将患者分为 PVI 组（PVI 组）和单纯 GSV 反流组（VV 组）。从 GSV 股隐静脉连接处或大腿下段、手臂采集血样。采用电化学发光法检测雌二醇水平。
2007 年 1 月至 12 月，共 40 例女性患者纳入研究，其中 19 例存在 PVI 的静脉造影证据（PVI 组），21 例为 VV 组。静脉造影显示 PVI 组 14 例（74%）患者存在卵巢静脉功能不全，12 例（63%）患者存在扩张的子宫和卵巢丛，6 例（32%）患者存在髂内静脉功能不全。PVI 组 GSV 样本中雌二醇的中位数为 121pg/ml（范围：12-4300），而 VV 组为 75pg/ml（范围：9-1177）。在上肢，PVI 组患者的中位数为 78pg/ml（范围：15-121），VV 组为 68pg/ml（范围：13-568）。PVI 组患者的下肢/上肢比值明显高于 VV 组（中位数：1.9；范围：0.7-33）（p<0.002）。比值 1.4 时，鉴别 PVI 组和非 PVI 组患者的敏感性和特异性最高。
在源于 GSV 的静脉曲张患者中，伴有 PVI 的亚组患者的下肢雌二醇水平明显高于上肢。该观察结果可能可作为疑似 PVI 患者的诊断性检查。值得进一步研究。
