目的 提高对抗磷脂抗体综合征( antiphospholipid syndrome, APS)合并静脉血栓栓塞性疾病(venous thromboembolism, VTE)的诊疗认识.方法 回顾性分析山西大医院血管外科2013年2月—2017年12月诊治的以VTE为首发表现的APS患者37 例临床资料,对APS合并VTE的病因、诊疗方法进行总结.结果 37例均以VTE为首发表现,均有单侧或双侧下肢深静脉血栓形成,入院后查血浆抗磷脂抗体均阳性, 34例(91. 9% )血小板均减少(43～84) ×109/L,33例(89. 2% )活化部分凝血活酶时间延长48. 0～133. 5 s, D-二聚体水平均升高0. 425～6. 850 mg/L;均行肺动脉螺旋CT血管造影检查提示肺动脉栓塞9例. 37例确诊为APS并VTE.针对VTE,37例及时启动抗凝治疗(低分子肝素32例、磺达肝癸钠3例、阿加曲班2例) ,出院后改为口服抗凝药物维持(华法林28例、利伐沙班9例) ;8例酌情行下腔静脉滤器植入术、肺动脉溶栓术、Angiojet血栓抽吸术治疗.针对APS,23例应用糖皮质激素,19例应用免疫抑制剂,4例应用免疫球蛋白.37例经住院和院外个体化治疗后病情稳定.结论 不明原因的VTE患者需常规筛查抗磷脂抗体,对APS诊断明确者,后期需严密随访并全面评估抗凝治疗与出血风险,尽早行抗凝治疗以减少血栓不良事件的发生.%Objective To improve the diagnosis and treatment of antiphospholipid syndrome ( APS) compli-cated by venous thromboembolism ( VTE) . Methods A retrospective analysis was performed on 37 patients with APS complicated by VTE as initial manifestations who were treated in Department of Vascular Surgery of Shanxi Dayi Hospital from February 2013 to December 2017. The etiology, diagnosis and treatment of APS complicated by VTE was analyzed. Results All 37 patients showed VTE as the initial manifestation, with either unilateral or bilateral deep venous thrombosis ( DVT) of lower extremities. After admission, physical examinations revealed positive plasma antiphospholipid antibodies, and reduced platelets(43-84) ×109/L in 34(91. 9% ) patients. In 33 cases(89. 2% ), the activation time of partial thrombin was extended by 48. 0 to 133. 5 s, and the D-dimer was increased by an aver-age of 0. 425-6. 850 mg/L. Pulmonary artery spiral CT angiography revealed pulmonary embolism in 9 cases. A total of 37 cases were diagnosed with APS with VTE, and therefore treated with anticoagulant therapy (32 cases of low mo-lecular heparin, 3 cases of Fondaparinux sodium, and 2 cases of Argatroban Injection) , after discharge, an oral anti-coagulant was administered to prolong the anticoagulant treatment(warfarin in 28 cases, and rivaroxaban in 9). Sur-gical intervention were performed on 8 patients, including vena cava filter placement, pulmonary thrombolytic surgery, and Angiojet thrombosuction. For APS, 23 patients were treated with glucocorticoids, 19 with immunosup-pressive agents, and 4 with immunoglobulin. All 37 cases had stable condition after hospitalization and individualized outpatient treatment. Conclusion Unexplained VTE patients need to be routinely screened for antiphospholipid an-tibodies. Those who have a clear diagnosis of APS need to be closely followed up and fully evaluated for anticoagulant treatment and bleeding risk. Anticoagulant therapy should be performed as early as possible to reduce the occurrence of thrombotic adverse events.
展开▼
