Impact of environmental and hereditary risk factors on the clinical manifestation of thrombophilia in homozygous carriers of factor V:G1691A

Summary.  Background : Limited data exist on the clinical manifestations of homozygous factor (F)V:G1691A mutation (FV Leiden) and the impact of environmental and genetic risk factors. Objectives : To assess the contribution of these factors on the thrombophilic phenotype. Patients and methods : In a retrospective multicenter cohort study 165 individuals with homozygous FV:G1691A mutation, of whom 129 had previous venous thromboembolism (VTE), were included. To study the role of environmental risk factors, patients were compared by the use of a standardized questionnaire to 165 sex- and age-matched individuals (reference group A); of these, two had previous VTE. To assess the role of genetic risk factors, factor (F)II:G20210A and MTHFR:C677T were determined in individuals homozygous for FV:G1691A and in 177 healthy individuals without previous VTE (reference group B). Results : The first VTE occurred significantly earlier in women (median age 25 years) than men (35.5 years). In 81% of women and 29% of men an environmental risk factor was present before first VTE. Oral contraceptives increased the risk of thrombosis 4-fold [odds ratio (OR) 4.0, 95% confidence interval (CI) 1.7, 10.4] in women with homozygous FV:G1691A. Postoperative and post-traumatic VTE as first manifestation occurred in 13% and 15% of surgical/traumatic events in patients and in 0.7% and 1.8% in reference group A, respectively (OR 19.7, 95% CI 2.5, 154 and OR 9.2, 95% CI 1.1, 79.4). Heterozygous FII:G20210A was more prevalent in symptomatic patients (11.7%) compared with reference group B (2.8%, OR 4.6, 95% CI 1.6, 13.2). The prevalence of homozygous MTHFR:C677T genotype was similar in patients and reference group B. Conclusions : Our study supports the concept of thrombophilia as a multifactorial disorder. The knowledge of coexisting factors predisposing to VTE is useful for medical advice for primary and secondary prophylaxis in these patients.     

The 894 G > T variant of endothelial nitric oxide synthase (eNOS) increases the risk of recurrent venous thrombosis through interaction with elevated homocysteine levels.

BACKGROUND: Venous thrombosis is a multicausal disease involving both genetic as well as acquired risk factors. Hyperhomocysteinemia is associated with a 2-fold increased risk of recurrent venous thrombosis (RVT). Recently, the 894 G > T variant of endothelial nitric oxide synthase (eNOS) was postulated to be associated with hyperhomocysteinemia. OBJECTIVES: We hypothesized an interrelation of hyperhomocysteinemia, the eNOS 894 G > T variant and RVT risk. METHODS: The eNOS 894 G > T variant was studied in 170 cases with a history of RVT and 433 controls from the general population. RESULTS: The eNOS 894 TT genotype may increase RVT risk [odds ratio (OR) 1.3 (0.7-2.6)], but no association of the eNOS 894 G > T variant with elevated homocysteine was found in controls. Interestingly, in RVT cases the coexistence of both the 894 TT genotype and elevated tHcy levels (> 90th percentile) was more frequently present than in controls, which led to a substantially increased risk of recurrent venous thrombosis [fasting tHcy OR 5.3 (1.1-24.1), postload tHcy OR 6.5 (1.6-29.5)]. CONCLUSION: The results of the present study demonstrate that the eNOS 894 G > T variation interacts with elevated tHcy levels, leading to an increased risk of recurrent thrombotic events. This interaction points in the direction of S-nitrosation as a mechanism by which homocysteine exerts its detrimental effects on the hemostatic system.     

灯盏花素注射液联合奥扎格雷治疗脑血栓形成

目的探析灯盏花素注射液联合奥扎格雷治疗脑血栓形成的疗效及对脑血流动力学的影响。方法选择我院2012年1月至2015年7月收治83例脑血栓形成患者作为研究对象,随机分为观察组(n=42)与对照组(n=41),对照组入院后给予常规对症治疗,并应用奥扎格雷,观察组在对照组基础上联合灯盏花素注射液进行治疗,比较两组治疗前后脑血液流变学指标(低切全血黏度、高切全血黏度、血浆黏度、纤维蛋白原)、治疗总有效率及不良反应发生率。结果两组治疗前各项血液流变学指标之间差异无统计学意义(P0.05),治疗后两组各项指标均获得改善,组内前后差异有统计学意义(P0.05),且观察组治疗后以上低切全血黏度、高切全血黏度、血浆黏度、纤维蛋白原指标均低于对照组,差异有统计学意义(P0.05),提示该组各指标的下降幅度更大,提示得到更佳改善。观察组治疗总有效率为85.7%(36/42),明显高于对照组65.9%(27/41),差异有统计学意义(P0.05)。观察组不良反应发生率为16.7%(7/42),对照组为12.2%(5/41),差异无统计学意义(P0.05)。结论灯盏花素注射液联合奥扎格雷治疗脑血栓形成疗效甚佳,可减少血液有形成分的聚集并降低血液黏度,促进脑部血液动力学的改善,且安全性高。     

广州市6家三级甲等医院护士对深静脉血栓认知、态度和行为现状调查

目的：了解三级甲等医院护士对深静脉血栓认知、态度、行为(知信行)现状。方法对260名三级甲等医院护士对于深静脉血栓的认知、态度情况以及预防深静脉血栓的行为进行问卷调查。结果54.2%护士熟悉深静脉血栓形成的原因,86.5%的护士认为预防深静脉血栓很重要,36.2%的护士会经常指导患者预防措施,80.4%的护士认为没有合适的工具。结论护士对于深静脉血栓有一定的认知度,对于深静脉血栓预防态度积极,但是大部分护士在临床工作中预防DVT行为不足。     

Caprini评估模型筛选老年重症肺炎深静脉血栓的有效性

目的 分析老年重症肺炎合并深静脉血栓(deep venous thrombosis,DVT)的临床特点,回顾性验证Caprini风险评估模型筛选老年重症肺炎静脉血栓栓塞症的有效性.方法 采用病例对照研究设计,收集2015年度本院内科年龄≥65岁,重症肺炎合并DVT患者50例为病例组,采用随机数字表法与病例组2:1比例随机选取同时期的老年重症肺炎无DVT患者100例为对照组.回顾性收集患者临床表现、实验室检查、治疗等相关资料,采用Caprini评估量表对两组患者进行评分及VTE危险度分级.比较两组临床表现、凝血功能、炎性指标,采用多因素logistic回归分析重症肺炎患者DVT风险因素,及VTE危险度分级与重症肺炎患者VTE发病风险的关系.结果 两组临床表现中,DVT组卧床、下肢水肿及中心静脉置管的人数明显高于对照组(P＜0.05),凝血指标显示DVT组D二聚体值(1718±140) mg/L显著高于对照组(923±76) mg/L(P＜0.05),炎性指标显示DVT组的C反应蛋白值(87.75 ± 6.78) mg/L显著高于对照组(56.29±4.43) mg/L(P＜0.05),对照组血红蛋白值(117±26)g/L显著高于DVT组(105±22) g/L (P＜0.05),且对照组的抗凝治疗率明显高于DVT组(P＜0.05).回归分析显示下肢水肿、中心静脉置管、D二聚体值与血栓发生显著相关(P＜0.05).DVT组Caprini评分均值(8.92±2.72)显著高于对照组(7.16±2.15) (P＜0.05).极高危组和高危组对比,随着评分等级的增加患者发生VTE的风险明显增加,评分≥9分的极高危患者发生VTE的风险是高危组的3.313倍(P＜0.05).结论 老年重症肺炎患者下肢水肿、中心静脉置管及D二聚体值与血栓发生显著相关.Caprini风险分级能够有效的预测重症肺炎患者血栓发生的风险,值得临床推广.     

达比加群酯与低分子肝素预防髋关节置换术后下肢深静脉血栓的作用比较

目的 比较达比加群酯与低分子肝素预防髋关节置换术后并发下肢深静脉血栓（DVT）的疗效与安全性的差异。方法 选择2014年1月至2015年10月在宣城中心医院住院的单髋或双髋关节置换术患者73例,随机分为基础治疗组（对照组）24例,达比加群酯组（DE组）25例,低分子肝素组（LMWH组）24例。置换后行双下肢彩色多普勒检查评估DVT形成情况,并观察比较各组患者治疗前后血小板计数,凝血酶元时间（PT）变化情况及安全性。结果 DE组和LMWH预防DVT效果优于对照组（P<0.05）,而DE组和LMWH组患者在预防DVT发生上差异无统计学意义（P>0.05）。DE组和LMWH组在治疗期间均无严重出血。结论 达比加群酯与低分子肝素均具有较好的预防髋关节置换后DVT的发生,达比加群酯疗效及安全性与低分子肝素作用相当。     

术前针刺对高龄股骨粗隆间骨折后高凝血状态的影响

【目的】观察术前应用针刺对高龄股骨粗隆间骨折后高血凝状态的影响。【方法】将60例符合入组条件的高龄股骨粗隆间骨折患者按随机数字表法随机分为对照组和针刺组,各30例。对照组予伤科黄水纱外敷治疗;针刺组在对照组疗法的基础上加用针刺治疗,选取双侧环跳、血海、梁丘、足三里、三阴交、太冲等穴。2组均治疗至术前1 d。观察治疗前后血栓弹力图(TEG)各参数水平变化及深静脉血栓(DVT)发生情况。【结果】治疗后,对照组TEG各参数与治疗前比较差异无统计学意义(P0.05),而针刺组与治疗前比较,凝血反应(R)时间、凝固(K)时间显著延长(P0.05),α角、血栓的最大幅度(MA)值和血栓硬度(G)值显著减小(P0.05),且针刺组延长R、K时间,降低α角、MA值和G值作用均优于对照组(P0.05)。术前1 d,血管彩超检查发现对照组有3例DVT形成,针刺组无DVT形成,2组比较差异无统计学意义(P0.05)。【结论】术前应用针刺可改善髋部骨折后的高血凝状态。     

腹部创伤患者发生深静脉血栓的影响因素

目的：分析腹部创伤患者发生深静脉血栓的影响因素。方法选取2014年6月至2015年6月该院收治的腹部创伤患者200例,均经彩色多普勒超声检查是否发生深静脉血栓,回顾性分析患者的临床资料,对腹部创伤患者发生深静脉血栓的影响因素进行分析。结果200例患者中56例在腹部创伤后7 d内表现出肌肉压痛、胀痛、Homans征阳性、浅静脉曲张和肢体皮温降低等症状与体征,经彩色多普勒超声检查60例患者确诊发生深静脉血栓。多因素Logistic回归分析结果显示,高龄、高胆固醇水平、高D‐二聚体水平、高尿素氮水平、合并高血压、合并糖尿病、合并高脂血症、术前1个月有手术史、下腹部创伤、高创伤评分、卧床时间大于3 d及有感染为腹部创伤患者发生深静脉血栓的独立危险因素（P＜0．05）。结论临床应对存在深静脉血栓危险因素的腹部创伤患者进行彩色多普勒超声筛查,有利于深静脉血栓的早发现、早治疗。     

北京协和医院静脉窦血栓患者临床特点及治疗的变化

目的 观察2001年至今北京协和医院诊治的脑静脉窦血栓形成(CVST)患者病因、临床表现、诊治方式与20世纪90年代的区别.方法 回顾1991年1月至2007年6月间35例CVST患者的资料,以2000年12月31日为界,分为A组(20世纪90年代)和B组(2001年后)两组进行比较.结果 (1)病因:A组以感染、血液系统异常多见.B组免疫系统异常、血液系统异常多见.(2)临床表现:CVST各症状阳性率为头痛86%,局灶性体征40%,意识障碍31%,癫痫发作34%,视力改变43%,眼底水肿60%;各症状完全缓解率由高到低依次为头痛、意识障碍、癫痫发作、局灶性体征、视力障碍;两组间各症状阳性率及缓解率差异均无统计学意义.(3)治疗:抗凝治疗A组有6例(38%),B组15例(79%),两组间差异有统计学意义.A组无溶栓患者,B组有4例行溶栓治疗.结论 2001年后北京协和医院就诊的CVST患者的病因构成有改变,但临床特点没有明显变化;治疗上抗凝和溶栓治疗增多.