临床误诊误治2018，Vol.31Issue(7)：4-8,5.DOI:10.3969/j.issn.1002-3429.2018.07.002
以静脉血栓栓塞性疾病为首发表现的抗磷脂抗体综合征37例个体化治疗分析
Analysis of the Individualized Treatment of 37 Patients with Antiphospholipid Syndrome with Venous Thromboembolism as Initial Manifestation
摘要
Abstract
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.关键词
抗磷脂综合征/静脉血栓形成/肺栓塞/诊断/治疗Key words
Antiphospholipid syndrome/Venous thrombosis/Pulmonary embolism/Diagnosis/Therapy分类
医药卫生引用本文复制引用
张文沛,张建陶,郝斌,续慧民,刘佳豪,杨涛..以静脉血栓栓塞性疾病为首发表现的抗磷脂抗体综合征37例个体化治疗分析[J].临床误诊误治,2018,31(7):4-8,5.基金项目
山西省软科学研究项目(2015041038-3) （2015041038-3）
