静脉血栓栓塞不同临床表现患者的危险因素概况：聚焦于凝血因子V莱顿突变

Risk factor profiles in patients with different clinical manifestations of venous thromboembolism: a focus on the factor V Leiden mutation.

作者信息

Manten B, Westendorp R G, Koster T, Reitsma P H, Rosendaal F R

机构信息

Department of Clinical Epidemiology, Leiden University Hospital, The Netherlands.

出版信息

Thromb Haemost. 1996 Oct;76(4):510-3.

PMID:8902987

Abstract

BACKGROUND

Patients with venous thromboembolic disease may present with different clinical manifestations. Factor V Leiden mutation leading to resistance to activated protein C is associated with a sevenfold increased risk for presenting with deep-vein thrombosis. It is not yet established whether carriers of the mutation have a similarly increased risk for manifesting with pulmonary embolism.

METHODS

From an Anticoagulation Clinic monitoring coumarin therapy, a consecutive series of patients with a first thromboembolic event (objectively proven by current radiological methods) were enrolled. All patients were interviewed and blood was drawn for genotyping. From the hospital charts and the personal interview, information was obtained on acquired risk factors and the signs and symptoms on hospital admission.

RESULTS

45 patients presented with symptoms of pulmonary embolism only, 211 had only symptoms of deep-vein thrombosis whereas 23 had clinical features of both. In about half of the patients acquired risk factors for venous thromboembolism were present which did not differ between the three groups of patients. Recent surgery had been performed more often in patients presenting with pulmonary embolism than in other patients (33.3% vs. 18.5%, p < 0.05). Factor V Leiden was present in 9% of the patients presenting with pulmonary embolism (relative risk: 3.3 95% CI: 1.0-10.6) and 17% of the patients presenting with deep-vein thrombosis (relative risk: 6.9 95% CI: 3.6-12.8). The prevalence of factor V Leiden was intermediate in patients with both clinical characteristics.

CONCLUSION

These data suggest that patients with venous thromboembolism have different clinical presentation depending on the risk factor profile. Factor V Leiden may preferentially lead to manifest deep-vein thrombosis. Differences in structure of venous thrombi could underlie differences in embolic tendency.

摘要

背景

静脉血栓栓塞性疾病患者可能有不同的临床表现。导致对活化蛋白C产生抵抗的凝血因子V莱顿突变与发生深静脉血栓形成的风险增加7倍相关。目前尚不清楚该突变携带者发生肺栓塞的风险是否也有类似增加。

方法

从一家监测香豆素治疗的抗凝门诊，纳入一系列连续的首次发生血栓栓塞事件（经当前放射学方法客观证实）的患者。对所有患者进行访谈并采血进行基因分型。从医院病历和个人访谈中获取有关获得性危险因素以及入院时的体征和症状的信息。

结果

45例患者仅表现出肺栓塞症状，211例仅有深静脉血栓形成症状，而23例同时具有两者的临床特征。约一半的患者存在静脉血栓栓塞的获得性危险因素，三组患者之间无差异。与其他患者相比，发生肺栓塞的患者近期手术更为常见（33.3%对18.5%，p<0.05）。凝血因子V莱顿在9%的肺栓塞患者中存在（相对风险：3.3，95%可信区间：1.0-10.6），在17%的深静脉血栓形成患者中存在（相对风险：6.9，95%可信区间：3.6-12.8）。在同时具有两种临床特征的患者中，凝血因子V莱顿的患病率处于中间水平。