本文選題：靜脈血栓栓塞癥　切入點(diǎn)：抗磷脂抗體綜合征　出處：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:本文對(duì)8例靜脈血栓栓塞癥合并抗磷脂抗體綜合征病例進(jìn)行臨床資料收集分析,總結(jié)其臨床特點(diǎn)、實(shí)驗(yàn)室檢查、影像學(xué)表現(xiàn)、治療方案及預(yù)后隨訪情況。以期提高對(duì)抗磷脂抗體綜合征的認(rèn)識(shí),改善靜脈血栓栓塞癥的預(yù)后,降低遠(yuǎn)期復(fù)發(fā)率。方法:收集2010年6月至2016年12月在浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院住院診治的靜脈血栓栓塞癥合并抗磷脂抗體綜合征患者的資料。分析患者的發(fā)病特點(diǎn)、危險(xiǎn)因素、實(shí)驗(yàn)室指標(biāo)、超聲心動(dòng)圖、下肢靜脈彩超、CT肺動(dòng)脈造影(computed tomographic pulmonary arteriography,CTPA)、治療及預(yù)后隨訪等情況。結(jié)果:8例靜脈血栓栓塞癥合并抗磷脂抗體綜合征臨床表現(xiàn)主要為胸悶、胸痛、呼吸困難、咯血和下肢腫脹痛,均為靜脈血栓栓塞癥典型表現(xiàn)。其他臨床特點(diǎn)包括血小板減少、活化部分凝血活酶時(shí)間APTT(activated partial thromboplastin time)延長(zhǎng)、合并腦梗死和/或腎梗死、血栓復(fù)發(fā)。8例患者均選擇低分子肝素、華法林/利伐沙班抗凝治療,隨訪期間內(nèi)未發(fā)生血栓復(fù)發(fā)。結(jié)論:靜脈血栓栓塞的患者臨床中若合并有不明原因的APTT延長(zhǎng)、多發(fā)血栓形成、正規(guī)抗凝血栓復(fù)發(fā)或合并有反復(fù)流產(chǎn)既往史的建議行抗磷脂抗體的篩查,排除是否合并有抗磷脂抗體綜合征可能。靜脈血栓栓塞癥合并抗磷脂抗體綜合征的患者抗凝治療,如無明顯出血風(fēng)險(xiǎn),建議予低分子肝素、華法林長(zhǎng)期甚至終身抗凝,預(yù)防血栓復(fù)發(fā)。對(duì)于繼發(fā)性抗磷脂抗體綜合征患者除抗凝治療外還需積極治療原發(fā)病。
[Abstract]:Objective: to collect and analyze the clinical data of 8 patients with venous thromboembolism complicated with anti-phospholipid antibody syndrome, and to summarize the clinical features, laboratory examination and imaging findings. To improve the understanding of anti-phospholipid antibody syndrome and improve the prognosis of venous thromboembolism. Methods: from June 2010 to December 2016, the data of patients with venous thromboembolism complicated with anti-phospholipid antibody syndrome were collected and analyzed. Risk factors, laboratory parameters, echocardiography, CT pulmonary angiography of lower extremity venous color Doppler ultrasound and tomographic pulmonary arteriography, treatment and prognosis were followed up. Results the clinical manifestations of 8 cases of venous thromboembolism with anti-phospholipid antibody syndrome were mainly chest tightness. Chest pain, dyspnea, hemoptysis and swelling pain of lower extremity are typical manifestations of venous thromboembolism. Other clinical features include thrombocytopenia, prolonged activated partial thromboplastin time (APTT(activated partial thromboplastin time), cerebral infarction and / or renal infarction. Low molecular weight heparin (LMWH) and warfarin / rivastaben were used in all patients with thrombotic recurrence. No thrombus recurrence occurred during the follow-up period. Conclusion: in patients with venous thromboembolism, APTT prolongation with unknown cause was found in the patients with venous thromboembolism. Multiple thrombus formation, recurrence of regular anticoagulant thrombus or previous history of recurrent abortion are recommended for screening for anti-phospholipid antibodies. Anticoagulant therapy for patients with venous thromboembolism associated with anti-phospholipid antibody syndrome is recommended for low molecular weight heparin (LMWH), warfarin for long term or even lifetime anticoagulation if there is no significant risk of bleeding. Prevention of thrombus recurrence. In addition to anticoagulant therapy, the patients with secondary anti-phospholipid antibody syndrome should be actively treated with primary diseases.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R593.2;R543.6

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