静脉血栓栓塞症的原发性及继发性危险因素分析

Analysis of the Primary and Secondary Risk Factors of Venous Thromboembolism

摘要: 目的：通过分析108例静脉血栓栓塞症(VTE)患者的临床资料，检查患者蛋白C (PC)、蛋白S (PS)、抗凝血酶III (ATIII)活性水平，探讨原发性和继发性危险因素与静脉血栓栓塞症的关系，为VTE的及早预防提供理论依据。方法：收集克拉玛依市中心医院108例VTE病例组(2014年1月至2019年1月收治的VTE)及52例对照组患者的临床资料，检测PC、PS、ATIII活性等指标，分析抗凝蛋白缺陷与VTE的关系，及患者年龄、性别、临床特征及继发性危险因素。结果：VTE患者的PC、PS、ATIII活性结果与对照组比较明显降低，差异有统计学意义(P < 0.05)。以PS缺陷所占比例最多(18.5%)，其次是PC缺陷(13.7%)和ATIII缺陷10.5%)，差异具有统计学意义(χ² = 25.46, P < 0.05)。复发组与初发组比较抗凝蛋白缺陷发病率差异具有统计学意义(χ² = 5.733, P < 0.05)，继发性危险因素中前二位是外伤/手术(骨科手术最多)、恶性肿瘤(消化道肿瘤 > 肺癌 > 妇科肿瘤 > 泌尿系肿瘤 > 乳腺癌)。恶性肿瘤合并VTE患者的比例最高。结论：蛋白C (Protein C, PC)、蛋白S (Protein S, PS)和抗凝血酶III (Antithrombin III, ATIII)缺陷是促发VTE发生的重要原发性危险因素，以PS、PC缺陷为主，抗凝蛋白缺陷可能是血栓复发的重要危险因素。继发性危险因素以外伤/手术和恶性肿瘤为主。多种因素并存是引起VTE的重要原因。

Abstract: Objective: By analyzing the clinical data of 108 patients with VTE, the activity levels of protein C (PC), protein S (PS), antithrombin III (ATIII) were examined, and the relationship between the primary and secondary risk factors and VTE was discussed to provide theoretical basis for the early preven-tion of VTE. Method: The clinical data of 108 cases of VTE (VTE admitted from January 2014 to Janu-ary 2019) and clinical data of 52 patients in the control group were collected to detect the activity of PC, PS and ATIII, analyze the relationship between anticoagulant protein deficiency and VTE, and the age, gender, clinical characteristics and secondary risk factors of patients. Results: The activity of PC, PS and ATIII in VTE patients was significantly lower than that in the control group (P < 0.05). PS defects accounted for the most (18.5%). The difference was statistically significant (χ² = 25.46, P < 0.05). The incidence rate of anticoagulant protein deficiency in relapse group was significantly different from that in the initial group (χ² = 5.733, P < 0.05). The top two secondary risk factors were trauma/surgery (Department of orthopedics operation), malignant tumor. The proportion of patients with VTE is the highest. Conclusion: The defects of PS, PC and at ATIII are the important primary risk factors for VTE. The defect of anticoagulant protein may be the important risk factors for thrombosis recurrence. The main secondary risk factors were trauma/operation and malignant tumor. The coexistence of many factors is an important cause of VTE.