您的位置:山东大学 -> 科技期刊社 -> 《山东大学学报(医学版)》

山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (7): 38-42.doi: 10.6040/j.issn.1671-7554.0.2021.0482

• • 上一篇    下一篇

影响孕产妇下肢深静脉血栓预后的危险因素分析

陈丽宇1,肖娟2,吕仙忠1,段宝敏1,洪凡真1   

  • 出版日期:2021-07-10 发布日期:2021-07-16
  • 通讯作者: 洪凡真. E-mail:hongfz@sdu.edu.cn

Risk factors influencing prognosis of lower extremity deep vein thrombosis in pregnant and parturient women

CHEN Liyu1, XIAO Juan2, LYU Xianzhong1, DUAN Baomin1, HONG Fanzhen1   

  1. 1. Department of Obstetrics;
    2. Center of Evidence-based Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong, China
  • Online:2021-07-10 Published:2021-07-16

摘要: 目的 通过对孕产妇下肢深静脉血栓(DVT)患者进行预后随访,探讨影响孕产妇DVT预后的危险因素。 方法 选取2015年12月至2020年1月于山东大学第二医院产科产检并分娩的DVT孕产妇(n=37)的临床资料进行回顾性分析根据血栓是否消失将其分为血栓完全消失组(n=13)和血栓机化残留组(n=24),采用独立样本t检验秩和检验(Mann-Whitney U检验)、χ2检验对两组患者的临床特征、实验室指标及静脉血栓栓塞(VTE)危险因素评分进行单因素分析。 结果 血栓完全消失组D-二聚体为1 340.50(659.00,2 447.75)ng/mL,血栓机化残留组D-二聚体为3 105.00(1 709.50,6 146.00)ng/mL,差异有统计学意义(P=0.009);VTE危险因素评分:血栓完全消失组为(3.31±1.11)分,血栓机化残留组为(4.96±1.94)分,差异有统计学意义(P=0.002);本次妊娠并发子痫前期例数:血栓完全消失组0例(0%),血栓机化残留组6例(25%),差异有统计学意义(P=0.038)。 结论 D-二聚体高浓度、 VTE危险因素高评分、并发子痫前期是孕产妇DVT患者血栓机化残留的危险因素。

关键词: 下肢深静脉血栓, D-二聚体, VTE危险因素评分, 预后随访, 危险因素

Abstract: Objective To investigate the risk factors affecting the prognosis of deep vein thrombosis(DVT)in pregnant and parturient women. Methods Clinical data of 37 pregnant women with DVT who underwent obstetric examination and delivered in The Second Hospital of Shandong University during Dec. 2015 and Jan. 2020 were retrospectively analyzed. According to thrombus status, the subjects were divided into two groups: thrombus disappearance group(n=13)and thrombus residue group(n=24). Independent sample t test, rank sum test(Mann-Whitney U test)and χ2 test were used for univariate analysis of clinical characteristics, laboratory indicators and VTE risk factors score of the two groups. Results The D-dimer was 1 340.50(659.00, 2 447.75)ng/mL in the thrombus disappearance group, and 3 105.00(1 709.50, 6 146.00)ng/mL in the thrombus reside group(P=0.009). VTE risk factors score was 3.31±1.11 in the thrombus disappearance group and 4.96±1.94 in the thrombus residue group(P=0.002). The number of cases complicated with preeclampsia during pregnancy was 0 case(0%)in the thrombus disappearance group and 6 cases(25%)in the thrombus residue group(P=0.038). Conclusion High score of VTE risk factors, complicated preeclampsia and high concentration of D-dimer are the risk factors for residual thrombus in pregnant and maternal DVT patients.

Key words: Deep vein thrombosis, D-dimer, VTE risk factors score, Prognosis and follow-up, Risk factors

中图分类号: 

  • R714.25
[1] Olaf M, Cooney R. Deep venous thrombosis [J]. Emerg Med Clin North Am, 2017, 35(4): 730-770.
[2] Heit JA, Kobbervig CE, James AH, et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study [J]. Ann Intern Med, 2005, 143(10): 697-706.
[3] Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism [J]. Eur Heart J, 2014, 35(43): 3033-3069.
[4] Galambosi PJ, Gissler M, Kaaja RJ, et al. Incidence and risk factors of venous thromboembolism during postpartum period: a population-based cohort-study [J]. Acta Obstet Gynecol Scand, 2017, 96(7): 852-861.
[5] Souza AS, Patriota AF, Guerra GV, et al. Evaluation of perinatal outcomes in pregnant women with preterm premature rupture of membranes [J]. Rev Assoc Med Bras, 2016, 62(3): 269-275.
[6] 刘真, 孙瑜. 妊娠期及产褥期静脉血栓栓塞疾病诊治: 2015年英国皇家妇产科医师学会指南解读[J]. 中华围产医学杂志, 2017, 20(12): 841-845. LIU Zhen, SUN Yu. Diagnosis and treatment of venous thromboembolism during pregnancy and puerperium: a review of the 2015 Royal College of Obstetricians and Gynaecologists Guidelines [J]. Chinese Journal of Perinatal Medicine, 2017, 20(12): 841-845.
[7] 刘瑶. 彩色多普勒超声诊断下肢深静脉血栓的临床应用[J]. 中国医药指南, 2020, 18(22): 56-57. LIU Yao. Clinical application of color Doppler ultrasonography in diagnosis of deep venous thrombosis of lower extremity [J]. Chinese Medicine Guide, 2020, 18(22): 56-57.
[8] Parsi K, Panozzo B, Bull A, et al. Deep vein sclerosis following sclerotherapy: Ultrasonic and d-dimer criteria [J]. Phlebology, 2020, 35(5): 325-336.
[9] Taherkhani R, Farshadpour F, Makvandi M, et al. Determination of cytomegalovirus prevalence and glycoprotein Bgenotypes among ulcerative colitis patients in Ahvaz, Iran [J]. Jundishapur J Microbiol, 2015, 8(2): 458-459.
[10] Zhao X, Ali SJ, Sang X. Clinical study on the screening of lower extremity deep venous thrombosis by D-dimer combined with RAPT score among orthopedic trauma patients [J]. India Orthop, 2020, 54(2): 316-321.
[11] Van Hylckama Vlieg A, Baglin CA, Luddington R, et al. The risk of a first and a recurrent venous thrombosis associated with an elevated D-dimer level and an elevated thrombin potential: results of the THE-DVT study [J]. J Thromb Haemost, 2015, 13(9): 1642-1652.
[12] 朱名超, 朱娅. D-二聚体和纤维蛋白原降解产物检测在骨折患者深静脉血栓中的诊断价值分析[J]. 中华临床实验室管理电子杂志, 2020, 8(4): 241-245. ZHU Mingchao, ZHU Ya. Analysis of the diagnostic value of D-dimer and fibrinogen degradation products in patients with deep vein thrombosis [J]. Chinese Journal of Clinical Laboratory Management(Electronic Edition), 2020, 8(4): 241-245.
[13] Kruger PC, Eikelboom JW, Douketis JD, et al. Deep vein thrombosis: update on diagnosis and management [J]. Med J Aust, 2019, 210(11): 516-524.
[14] Duffett L, Kearon C, Rodger M, et al. Treatment of superficial vein thrombosis: a systematic review and meta-analysis [J]. Thromb haemost, 2019, 119(3): 479-489.
[15] 宋春凤, 李辉, 田博, 等. 胸外科术后静脉血栓栓塞症发生情况的单中心前瞻性队列研究[J]. 中华外科杂志, 2018, 56(4): 284-288. SONG Chunfeng, LI Hui, TIAN Bo, et al. A single-center prospective cohort study of venous thromboembolism after thoracic surgery [J]. Chinese Journal of Surgery, 2018, 56(4): 284-288.
[16] Wang MM, Qin XJ, He XX, et al. Comparison and screening of different risk assessment models for deep vein thrombosis in patients with solid tumors [J].J Thromb Thrombolysis, 2019, 48(2): 292-298.
[17] Adrados C, Trastour C, Havet J, et al. Diagnosis of postpartum abdominal pain: About a rare case of portal vein thrombosis [J]. Gynecol Obstet Fertil, 2015, 43(1): 68-70.
[18] Carter EB, Conner SN, Cahill AG, et al. Impact of fetal growth on pregnancy outcomes in women with severe preeclampsia [J]. Pregnancy Hypertension, 2017, 8(32): 21-25.
[19] Zacharia BE, Kahn S, Bander ED, et al. Incidence and risk factors for preoperative deep venous thrombosis in 314 consecutive patients undergoing surgery for spinal metastasis [J]. J Neurosurg Spine, 2017, 27(2): 189-197.
[20] 王子莲, 耿慧珍, 赵先兰, 等. 中国九家医院孕产妇静脉血栓栓塞症的发病现状及危险因素调查[J]. 中华妇产科杂志, 2020, 55(10): 667-672. WANG Zilian, GENG Huizhen, ZHAO Xianlan, et al. The prevalence of venous thromboembolism in pregnant women in China [J]. Chinese Journal of Obstetrics and Gynecology, 2020, 55(10): 667-672.
[21] 李佳瑾, 沈祥丽. 妊娠期高血压疾病产妇的凝血功能状况及其与深静脉血栓的相关性分析[J]. 中国妇幼保健, 2019, 34(6): 1259-1261. LI Jiajin, SHEN Xiangli. Blood coagulation and deep venous thrombosis in pregnant women with hypertension [J]. Chinese Journal of Maternal and Child Health, 2019, 34(6): 1259-1261.
[22] Egan K, Kevane B, Ni Ainle F. Elevated venous thromboembolism risk in preeclampsia: molecular mechanisms and clinical impact [J]. Biochem Soc Trans, 2015, 43(4): 696-701.
[1] 黄玉真,吕琛,颜磊,李帅帅,张景雪,刘超,王银霞,桑岩岩,房鹛. 基于危险因素筛查的延续性院外管理对卵巢过度刺激综合征的预防效果[J]. 山东大学学报 (医学版), 2026, 64(4): 92-99.
[2] 逄锦宏,苏萍,乔俊鹏,陈巧巧,陈学禹,赵颖颖,施婕,孙晓茹,李秋春,何蕊言,范轶欧,迟蔚蔚. 老年人群可改变心血管危险因素聚集模式与脑卒中的关联[J]. 山东大学学报 (医学版), 2025, 63(9): 11-19.
[3] 张政,王建伟,杨玉娟,张宇,宋西成. 哮喘儿童2008及2019年免疫球蛋白E变化及相关危险因素[J]. 山东大学学报 (医学版), 2025, 63(7): 32-36.
[4] 李敬,郝盼盼. 急性心力衰竭患者出入院心率变化与预后相关性[J]. 山东大学学报 (医学版), 2025, 63(4): 75-82.
[5] 程震宇,来庆国,吴梦涛. 髂股静脉支架置入术后再狭窄的影响因素研究进展[J]. 山东大学学报 (医学版), 2025, 63(12): 112-117.
[6] 程跃启,王斐,于理想,郑超,余之刚. 曲妥珠单抗致HER2阳性乳腺癌患者心脏毒性的研究进展[J]. 山东大学学报 (医学版), 2025, 63(1): 17-24.
[7] 王浙宇,许懿,赵昌波,杨硕菲,倪其泓,陈佳佺,王韦仑,李一男,郭相江,叶猛,张岚,薛冠华. 腹主动脉瘤腔内修复术后发生髂支闭塞的危险因素及处理对策[J]. 山东大学学报 (医学版), 2024, 62(9): 101-107.
[8] 郭鑫,孟君,郑世良,董秀红. 老年胃癌患者衰弱与人体成分的相关性[J]. 山东大学学报 (医学版), 2024, 62(4): 40-47.
[9] 李建,孙云. 新入维持性血液透析患者2年内死亡的危险因素[J]. 山东大学学报 (医学版), 2024, 62(4): 48-53.
[10] 宋甜田,李作坤,王书会. 个体化预测老年心脏瓣膜置换术后医院感染风险Nomogram模型的构建[J]. 山东大学学报 (医学版), 2024, 62(1): 48-56.
[11] 曲永强,赵泽宇,吴兴原,韩玮,段瑞生,李衍滨,李亨. 颈动脉分叉处支架置入术后严重持续性低血压的危险因素[J]. 山东大学学报 (医学版), 2023, 61(7): 78-82.
[12] 宋晗,王振华,韦铎亮,徐凯,李博文,赵鑫. 术前MELD分级对304例急性StandfordA型主动脉夹层患者术后早期结局的影响[J]. 山东大学学报 (医学版), 2023, 61(5): 31-36.
[13] 张蒙,马伟. 1990—2019年中国人类免疫缺陷病毒/获得性免疫缺陷综合征流行趋势及疾病负担[J]. 山东大学学报 (医学版), 2023, 61(5): 84-89.
[14] 穆彦熹,李金洲,陈康,梁红英,姚亚龙,汪文杰,陈晓. 443例胃癌根治术后发生肺部并发症的危险因素[J]. 山东大学学报 (医学版), 2023, 61(4): 37-41.
[15] 邵长秀,贺青卿,庄晓璇,李小磊,周鹏,岳涛,高远,徐婧,李陈钰,郭浩男,庄大勇. 934例甲状腺微小乳头状癌颈淋巴结部位转移及危险因素[J]. 山东大学学报 (医学版), 2023, 61(2): 57-64.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!