Department of Pediatrics, The Center for Cancer and Blood Disorders, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO, USA.
Department of Pediatrics, The Center for Cancer and Blood Disorders, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO, USA; University of Colorado Hemophilia and Thrombosis Center, Aurora, CO, USA.
Thromb Res. 2017 Oct;158:161-166. doi: 10.1016/j.thromres.2017.08.022. Epub 2017 Sep 5.
Pediatric venous thromboembolism (VTE) is a rare but serious medical condition. Cystic fibrosis (CF) is a risk for recurrent pediatric VTE and has potential thrombophilic tendency. However, much remains unknown, including incidence and intrapopulation risk factors.
A retrospective cohort of pediatric CF patients followed at Children's Hospital Colorado from January 1st 2003 through May 20th 2016 was examined. Cases were identified by informatics and validated manually. Data on CF severity, co-morbidities and treatment, central venous catheter (CVC) use, and thrombophilia were obtained from an institutional CF database and chart review.
Nineteen VTE occurred in 458 participants followed for 3595 person-years, yielding an incidence rate of 53 VTE per 10,000 children with CF. VTE cases had additional co-morbidities including CF-related diabetes (p=0.002) and sinus disease (p=0.04), more total admissions (p<0.001), admit days (p<0.001), positive respiratory cultures (p<0.001), pseudomonas infections (p<0.001), steroid courses (p=0.001), and total CVC days (PICC p=0.03, port p=0.007). On univariate analysis, older age (RR 1.162, p=0.007), sinus disease (RR 2.62, p=0.05), longer hospital stay (RR 1.03, p<0.001), higher ESR (RR 1.02, p=0.03) and CRP (RR 1.07, p=0.007), and an absence of systemic steroids (RR 0.19, p=0.004) increased the risk of VTE.
In this cohort, children with CF had a higher incidence of VTE when compared to the previously reported incidence in the overall pediatric population at Children's Hospital Colorado. Overall, those with VTE had a greater disease burden and older age, sinus disease, longer hospitalization and increased inflammation were VTE risk factors.
儿科静脉血栓栓塞症（VTE）是一种罕见但严重的医学病症。囊性纤维化（CF）是小儿 VTE 反复发作的危险因素，且具有潜在的血栓形成倾向。然而，目前仍有许多未知因素，包括发病率和人群内的风险因素。
对 2003 年 1 月 1 日至 2016 年 5 月 20 日期间在科罗拉多儿童医院接受治疗的儿科 CF 患者进行回顾性队列研究。通过信息学手段识别病例，并通过病历回顾进行人工验证。从机构 CF 数据库中获取 CF 严重程度、合并症和治疗、中心静脉导管（CVC）使用以及血栓形成倾向的数据。
在 458 名随访 3595 人年的参与者中，19 例发生 VTE，CF 患儿每 10000 人中有 53 例发生 VTE，发病率为 53 例/10000 人。VTE 病例还存在其他合并症，包括 CF 相关糖尿病（p=0.002）和窦炎（p=0.04）、总住院次数更多（p<0.001）、住院天数更多（p<0.001）、呼吸道培养阳性（p<0.001）、铜绿假单胞菌感染（p<0.001）、类固醇疗程（p=0.001）和总 CVC 天数（PICC p=0.03，端口 p=0.007）。单因素分析显示，年龄较大（RR 1.162，p=0.007）、窦炎（RR 2.62，p=0.05）、住院时间延长（RR 1.03，p<0.001）、ESR 升高（RR 1.02，p=0.03）和 CRP 升高（RR 1.07，p=0.007），以及无全身类固醇（RR 0.19，p=0.004）增加了 VTE 的风险。
在本队列中，与科罗拉多儿童医院儿科总体人群先前报告的发病率相比，CF 患儿 VTE 的发病率更高。总体而言，患有 VTE 的患儿疾病负担更重，年龄较大，伴有窦炎、住院时间延长和炎症增加是 VTE 的危险因素。
