Abelyan Gohar, Abrahamyan Lusine, Yenokyan Gayane
1 School of Public Health, American University of Armenia, Yerevan, Armenia.
2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, Canada.
Phlebology. 2018 Feb;33(1):60-67. doi: 10.1177/0268355516687677. Epub 2017 Jan 11.
Background/objectives Venous ulcers carry psychological and high financial burden for patients, causing depression, pain, and limitation of mobility. The study aimed to identify factors associated with an increased risk of venous ulceration in patients with varicose veins in Armenia. Methods A case-control study design was utilized enrolling 80 patients in each group, who underwent varicose treatment surgery in two specialized surgical centers in Armenia during 2013-2014 years. Cases were patients with varicose veins and venous leg ulcers. Controls included patients with varicose veins but without venous leg ulcers. Data were collected using interviewer-administered telephone interviews and medical record abstraction. Multiple logistic regression analysis was used to identify the risk factors of venous ulceration. Results There were more females than males in both groups (72.5% of cases and 85.0 % of controls). Cases were on average older than controls (53.9 vs. 39.2 years old, p ≤ 0.001). After adjusting for potential confounders, the estimated odds of developing venous ulcer was higher in patients with history of post thrombotic syndrome (odds ratio = 14.90; 95% confidence interval: 3.95-56.19; p = 0.001), with higher average sitting time (odds ratio = 1.32 per hour of sitting time; 95% confidence interval: 1.08-1.61; p = 0.006), those with reflux in deep veins (odds ratio = 3.58; 95% confidence interval: 1.23-10.31; p = 0.019) and history of leg injury (odds ratio = 3.12; 95% confidence interval: 1.18-8.23; p = 0.022). Regular exercise in form of walking (≥5 days per week) was found to be a protective factor from venous ulceration (odds ratio = 0.26; 95% confidence interval: 0.08-0.90; p = 0.034). Conclusion We found that reflux in deep veins, history of leg injury, history of post thrombotic syndrome, and physical inactivity were significant risk factors for venous ulceration in patients with varicose veins, while regular physical exercise mitigated that risk. Future studies should investigate the relationships between the duration and type of regular exercise and the risk of venous ulceration to make more specific recommendations on preventing ulcer development.
背景/目的 静脉溃疡给患者带来心理和沉重的经济负担，导致抑郁、疼痛和行动受限。本研究旨在确定亚美尼亚静脉曲张患者中与静脉溃疡风险增加相关的因素。方法 采用病例对照研究设计，每组纳入80例患者，这些患者于2013 - 2014年期间在亚美尼亚的两个专业外科中心接受了静脉曲张治疗手术。病例为患有静脉曲张和下肢静脉溃疡的患者。对照包括患有静脉曲张但无下肢静脉溃疡的患者。通过访员进行的电话访谈和病历摘要收集数据。采用多因素逻辑回归分析来确定静脉溃疡的危险因素。结果 两组中女性均多于男性（病例组占72.5%，对照组占85.0%）。病例组平均年龄大于对照组（53.9岁对39.2岁，p≤0.001）。在对潜在混杂因素进行调整后，有血栓形成后综合征病史的患者发生静脉溃疡的估计比值较高（比值比 = 14.90；95%置信区间：3.95 - 56.19；p = 0.001），平均久坐时间较长者（每久坐一小时的比值比 = 1.32；95%置信区间：1.08 - 1.61；p = 0.006），深静脉反流者（比值比 = 3.58；95%置信区间：1.23 - 10.31；p = 0.019）以及有腿部受伤史者（比值比 = 3.12；95%置信区间：1.18 - 8.23；p = 0.022）。以步行形式的规律运动（每周≥5天）被发现是预防静脉溃疡的保护因素（比值比 = 0.26；95%置信区间：0.08 - 0.90；p = 0.034）。结论 我们发现深静脉反流、腿部受伤史、血栓形成后综合征病史和缺乏身体活动是静脉曲张患者发生静脉溃疡的重要危险因素，而规律的体育锻炼可降低该风险。未来的研究应调查规律运动的持续时间和类型与静脉溃疡风险之间的关系，以便就预防溃疡形成提出更具体的建议。
