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遗传性易栓症与肺栓塞。

Inherited trombophilic states and pulmonary embolism.

作者信息

Konecny Filip

机构信息

St. Joseph Hospital and McMaster University, Ontario, Canada L8S4L8 and University of Veterinary Medicine and Pharmaceutical Sciences Brno, Czech Republic. E-mail:

出版信息

J Res Med Sci. 2009 Jan;14(1):43-56.

Abstract

Pulmonary embolism (PE) and deep vein thrombosis (DVT) are associated with considerable morbidity and mortality, mostly, in case of PE for its lack of sensitivity of its early detection. For as much as twenty-five percent of PE patients the primary clinical appearance is unexpected death. While PE is one of the most avertable causes of hospital associated deaths, its diagnostics can be extremely difficult. Newly increased interest in an inherited thrombophilic states has been provoked by the discovery of several common inherited abnormalities, i.e. the prothrombin (PT) gene G20210A, Factor V Leiden (FVL) mutation (Arg506Gln), hyperhomocystenemia and homocysteiuria, Wein-Penzing defect, Sticky Platelet Syndrome (SPS), Quebec platelet disorder (QPD) and Sickle Cell Disease (SCD). PE incidence rates increase exponentially with age for both men and women, as they might harbor more than one thrombophilic state. Although the impact of genetic factors on PE is to some extent documented with lacking taxonomy, its genetic testing as its prevention strategy fall short.In this review thrombophilic states are divided into inherited or acquired, and only the inherited and newly documented are more closely followed. Factors are further grouped based on its thrombophilic taxonomy into; inherited defects of coagulation, inherited defects of fibrinolysis, inherited defects of enzymatic pathway in relation to development of VTE and PE and inherited defects of platelets in relation to PE. It was beyond the scope of this review to follow all inherited and newly recognized factors and its association to VTE and PE; however the overall taxonomy makes this review clinically valuable i.e. in relation to genetic testing as PE prevention.

摘要

肺栓塞(PE)和深静脉血栓形成(DVT)与相当高的发病率和死亡率相关,主要是因为PE早期检测缺乏敏感性。多达25%的PE患者的主要临床表现是意外死亡。虽然PE是医院相关死亡中最可避免的原因之一,但其诊断可能极其困难。几种常见的遗传性异常的发现引发了对遗传性血栓形成倾向状态的新关注,即凝血酶原(PT)基因G20210A、因子V莱顿(FVL)突变(Arg506Gln)、高同型半胱氨酸血症和同型胱氨酸尿症、温-彭津缺陷、血小板黏附综合征(SPS)、魁北克血小板疾病(QPD)和镰状细胞病(SCD)。男性和女性的PE发病率均随年龄呈指数增长,因为他们可能存在不止一种血栓形成倾向状态。尽管遗传因素对PE的影响在某种程度上有文献记载,但分类不够明确,其基因检测作为预防策略也存在不足。在本综述中,血栓形成倾向状态分为遗传性或获得性,仅对遗传性和新记录的状态进行更密切的跟踪。根据血栓形成倾向分类,这些因素进一步分为:凝血的遗传性缺陷、纤维蛋白溶解的遗传性缺陷、与静脉血栓栓塞症(VTE)和PE发生相关的酶途径的遗传性缺陷以及与PE相关的血小板遗传性缺陷。本综述的范围不包括跟踪所有遗传性和新发现的因素及其与VTE和PE的关联;然而,总体分类使本综述具有临床价值,即与作为PE预防手段的基因检测相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7f9a/3129068/1aa52b2fd3c0/JRMS-14-43-g002.jpg

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