Golomb Beatrice A, Chan Virginia T, Denenberg Julie O, Koperski Sabrina, Criqui Michael H
Department of Medicine, University of California San Diego, La Jolla, California, USA.
BMJ Open. 2014 Mar 21;4(3):e003208. doi: 10.1136/bmjopen-2013-003208.
To examine the interrelations among, and risk marker associations for, superficial and deep venous events-superficial venous thrombosis (SVT), deep venous thrombosis (DVT) and pulmonary embolism (PE).
Cross-sectional analysis.
San Diego, California, USA.
2404 men and women aged 40-79 years from four ethnic groups: non-Hispanic White, Hispanic, African-American and Asian. The study sample was drawn from current and former staff and employees of the University of California, San Diego and their spouses/significant others.
Superficial and deep venous events, specifically SVT, DVT, PE and combined deep venous events (DVE) comprising DVT and PE.
Significant correlates on multivariable analysis were, for SVT: female sex, ethnicity (African-American=protective), lower educational attainment, immobility and family history of varicose veins. For DVT and DVE, significant correlates included: heavy smoking, immobility and family history of DVEs (borderline for DVE). For PE, significant predictors included immobility and, in contrast to DVT, blood pressure (BP, systolic or diastolic). In women, oestrogen use duration for hormone replacement therapy, in all and among oestrogen users, predicted PE and DVE, respectively.
These findings fortify evidence for known risk correlates/predictors for venous disease, such as family history, hormone use and immobility. New risk associations are shown. Striking among these is an association of PE, but not DVT, to elevated BP: we conjecture PE may serve as cause rather than consequence. Future studies should evaluate the temporal direction of this association. Oxidative stress and cell energy compromise are proposed to explain and predict many risk factors, operating through cell-death mediated triggering of coagulation activation.
研究表浅静脉事件（浅静脉血栓形成（SVT））、深静脉血栓形成（DVT）和肺栓塞（PE）之间的相互关系以及风险标志物关联。
横断面分析。
美国加利福尼亚州圣地亚哥。
来自四个种族群体（非西班牙裔白人、西班牙裔、非裔美国人和亚裔）的2404名年龄在40 - 79岁之间的男性和女性。研究样本来自加利福尼亚大学圣地亚哥分校的现任和前任教职员工及其配偶/重要他人。
表浅和深静脉事件，具体为SVT、DVT、PE以及包括DVT和PE的合并深静脉事件（DVE）。
多变量分析显示，与SVT显著相关的因素有：女性、种族（非裔美国人=有保护作用）、较低的教育程度、活动减少和静脉曲张家族史。与DVT和DVE显著相关的因素包括：大量吸烟、活动减少和DVE家族史（DVE为临界值）。与PE显著相关的预测因素包括活动减少，与DVT不同的是，还有血压（收缩压或舒张压）。在女性中，激素替代疗法的雌激素使用时长分别预测了PE和DVE，在所有女性以及雌激素使用者中均如此。
这些发现强化了已知的静脉疾病风险相关因素/预测因素（如家族史、激素使用和活动减少）的证据。显示了新的风险关联。其中引人注目的是PE（而非DVT）与血压升高的关联：我们推测PE可能是原因而非结果。未来研究应评估这种关联的时间方向。有人提出氧化应激和细胞能量受损可通过细胞死亡介导的凝血激活触发来解释和预测许多风险因素。
