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新型冠状病毒肺炎患者的深静脉血栓形成:一项队列分析。

Deep Venous Thrombosis in COVID-19 Patients: A Cohort Analysis.

机构信息

Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Co-first authors.

出版信息

Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620982669. doi: 10.1177/1076029620982669.

Abstract

Deep venous thrombosis (DVT) is a severe complication of coronavirus disease 2019 (COVID-19). The purpose of this study was to study the prevalence, risk factors, anticoagulant therapy and sex differences of DVT in patients with COVID-19. The enrolled 121 hospitalized non-ventilator patients were confirmed positive for COVID-19. All suspected patients received color Doppler ultrasound (US) to screen for DVT in both lower extremities. Multivariate logistic regression was performed to identify risk factors related to DVT in COVID-19 patients. DVT was found in 48% of the asymptomatic COVID-19 patients with an increased PADUA or Caprini index using US scanning. The multivariate logistic regression determined that age (OR, 1.05; = .0306), C-reactive protein (CRP) (OR, 1.02; = .0040), and baseline D-dimer (OR, 1.42; = .0010) were risk factors among COVID-19 patients. Although the most common DVT location was infrapopliteal (classes I and II), higher mortality in DVT-COVID-19 patients was confirmed. DVT-COVID-19 patients presented significant increases in CRP, neutrophil count, and D-dimer throughout the whole inpatient period compared to non-DVT-COVID-19 patients. Although anticoagulation therapy accelerated the recovery of lymphocytopenia in DVT patients, men DVT-COVID-19 patients with anticoagulant therapy showed significant higher CRP and neutrophil count vs. lymphocyte count (N/L) ratio, but showed lower lymphocyte counts compared to women DVT-COVID-19 patients. DVT is common in COVID-19 patients with high-risk factors, especially for older age and higher CRP and baseline D-dimer populations. It is important to consider sex differences in anticoagulant therapy among DVT-COVID-19 patients.

摘要

深静脉血栓形成(DVT)是 2019 年冠状病毒病(COVID-19)的严重并发症。本研究旨在研究 COVID-19 患者中 DVT 的患病率、危险因素、抗凝治疗和性别差异。纳入的 121 例住院非呼吸机患者的 COVID-19 均为阳性。所有疑似患者均接受彩色多普勒超声(US)筛查双侧下肢 DVT。采用多变量逻辑回归分析 COVID-19 患者 DVT 的相关危险因素。通过 US 扫描发现无症状 COVID-19 患者中有 48%的患者出现 DVT,PADUA 或 Caprini 指数增加。多变量逻辑回归确定年龄(OR,1.05;P=.0306)、C 反应蛋白(CRP)(OR,1.02;P=.0040)和基线 D-二聚体(OR,1.42;P=.0010)是 COVID-19 患者的危险因素。尽管最常见的 DVT 部位为小腿(I 类和 II 类),但 DVT-COVID-19 患者的死亡率更高。与非 DVT-COVID-19 患者相比,DVT-COVID-19 患者在整个住院期间 CRP、中性粒细胞计数和 D-二聚体均显著升高。尽管抗凝治疗加速了 DVT 患者淋巴细胞减少的恢复,但抗凝治疗的男性 DVT-COVID-19 患者的 CRP 和中性粒细胞计数与淋巴细胞计数(N/L)比值显著升高,但淋巴细胞计数明显低于女性 DVT-COVID-19 患者。DVT 在 COVID-19 患者中很常见,尤其是高龄和 CRP 及基线 D-二聚体水平较高的患者。在 COVID-19 患者中,抗凝治疗应考虑性别差异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9517/7783883/b5f7454e5b59/10.1177_1076029620982669-fig1.jpg

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