May-Thurner 综合征与急性下肢深静脉血栓形成患者肺栓塞风险的关系。
May-Thurner syndrome and the risk of pulmonary embolism in patients with acute deep venous thrombosis.
机构信息
Shandong University, Jinan, China; Department of Vascular Surgery, Affiliated Hospital of Jining Medical University, Jining, China.
Department of Vascular Surgery, Affiliated Hospital of Jining Medical University, Jining, China.
出版信息
J Vasc Surg Venous Lymphat Disord. 2018 Jul;6(4):433-440.e1. doi: 10.1016/j.jvsv.2018.01.007.
OBJECTIVE
Pulmonary embolism (PE) is the most common complication of deep venous thrombosis (DVT). May-Thurner syndrome (MTS) is known to increase the risk of DVT, but an association between MTS and PE has not been established. This study investigated an association between MTS and the risk of PE in patients with acute lower extremity DVT.
METHODS
Between June 2014 and September 2016, there were 112 patients with DVT at our hospital who underwent venous angiography and computed tomography pulmonary angiography. Data related to the patients' demographics, risk factors, disease onset time, side of DVT, D-dimer level, Doppler ultrasound, venous angiography, and computed tomography pulmonary angiography were collected. Associations between MTS and PE were analyzed.
RESULTS
The 112 DVT patients included 79 with MTS. The rate of DVT in the left lower extremity was higher in the MTS group (98.7%) than in the non-MTS group (48.5%; P < .001). PE was less common in the MTS group (50.6%) than in the non-MTS group (78.8%; P = .006). The multinomial logistic analysis revealed a significant negative correlation between MTS and PE. The correlation remained after applying adjustment models I, II, and III. Model I adjusted for risk factors, DVT side, and D-dimer tertile (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.04-0.68; P = .0125); model II adjusted for sex, age, risk factors, onset time, DVT side, D-dimer level, and D-dimer tertile (OR, 0.15; 95% CI, 0.03-0.71; P = .0162); and model III adjusted for sex, age, risk factors, onset time, DVT side, D-dimer level, D-dimer tertile, iliofemoral DVT, mixed (both iliofemoral and femoropopliteal) DVT, and femoropopliteal DVT (OR, 0.35; 95% CI, 0.06-2.08; P = .2501).
CONCLUSIONS
DVT patients with concomitant MTS have a decreased risk of PE compared with those without MTS. This finding extends previous reports of increased PE risk after DVT and calls for better understanding of shared risk factors and underlying mechanisms.
目的
肺栓塞（PE）是深静脉血栓（DVT）最常见的并发症。已知梅-特纳综合征（MTS）会增加 DVT 的风险，但 MTS 与 PE 之间的关联尚未确定。本研究旨在调查急性下肢 DVT 患者中 MTS 与 PE 风险之间的关系。
方法
2014 年 6 月至 2016 年 9 月，我院收治了 112 例 DVT 患者，均行静脉造影和 CT 肺动脉造影检查。收集患者的人口统计学、危险因素、发病时间、DVT 侧、D-二聚体水平、多普勒超声、静脉造影、CT 肺动脉造影等相关数据。分析 MTS 与 PE 之间的相关性。
结果
112 例 DVT 患者中，79 例合并 MTS。MTS 组左下肢 DVT 发生率（98.7%）明显高于非 MTS 组（48.5%；P<0.001）。MTS 组 PE 发生率（50.6%）明显低于非 MTS 组（78.8%；P=0.006）。多变量逻辑回归分析显示，MTS 与 PE 呈显著负相关。在应用模型 I、II 和 III 进行调整后，相关性仍然存在。模型 I 调整了危险因素、DVT 侧和 D-二聚体三分位（比值比[OR]，0.17；95%置信区间[CI]，0.04-0.68；P=0.0125）；模型 II 调整了性别、年龄、危险因素、发病时间、DVT 侧、D-二聚体水平和 D-二聚体三分位（OR，0.15；95%CI，0.03-0.71；P=0.0162）；模型 III 调整了性别、年龄、危险因素、发病时间、DVT 侧、D-二聚体水平、D-二聚体三分位、髂股 DVT、混合（髂股和股腘）DVT 和股腘 DVT（OR，0.35；95%CI，0.06-2.08；P=0.2501）。
结论
与无 MTS 的 DVT 患者相比，同时患有 MTS 的 DVT 患者发生 PE 的风险较低。这一发现扩展了先前报道的 DVT 后 PE 风险增加的报告，并呼吁更好地理解共同的危险因素和潜在机制。
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