急性下肢深静脉血栓形成的实验与临床研究  

Study on acute deep venous thrombosis of lower limb

作　　者：刘咸罗[1] 钱小星[1] 汤永胜[1] 陈克辉[1] 钱梅梅[1] 柳小刚[1] 周高潮[1] 徐晓峰[1] 王家文[1] 

机构地区：[1]合肥市第二人民医院血管外科,安徽合肥230011

出　　处：《中国现代普通外科进展》2009年第4期317-320,共4页Chinese Journal of Current Advances in General Surgery

基　　金：合肥市重点课题基金资助项目(合科0081008号)

摘　　要：目的:评价静脉造影和彩色多普勒超声检查对诊断急性下肢深静脉血栓形成(deep venousthrombosis,DVT)的临床价值以及高敏感性C-反应蛋白(highly sensitive C-reaction protein,hsCRP)作为DVT生物学观察指标的可行性。方法:先行动物实验。游离犬左后肢髂-股静脉,破坏血管内膜后注入凝血酶制作血栓模型,用彩色多普勒超声和静脉造影观察血栓再通情况及测定血液中的hsCRP。对2006年-2008年收治的急性膝关节近侧DVT患者77例行药物溶栓治疗,主要为尿激酶25万U静脉点滴,1次/d,共14d;低分子量肝素钙针0.4mL皮下注射,1～2次/d,共7～14d。入院和出院4周后均进行临床体格检查、静脉造影、血管彩色多普勒超声及血高敏感性CRP(hsCRP)测定等。结果:动物实验显示,彩色多普勒超声能更早、更准确地反映血栓再通情况;DVT形成后,hsCRP升高;血栓逐步消融,管腔通畅,hsCRP同步回落,两者呈正相关。49例DVT患者疗效满意,临床表现明显消退;23例好转;5例无效。出院4周复查静脉造影示血栓部分消融者15例,其余62例病变段均未显影;彩色多普勒超声检查则发现56例原闭塞段已可见部分管腔显示。入院时hsCRP为91.90～4.16mg/L,平均为(28.91±29.4)mg/L;出院4周后为46.90～0.92mg/L,平均为(8.13±12.7)mg/L。临床表现越严重,hsCRP越高。治疗无效者出院4周后hsCRP虽有下降,但仍居高位;1例病情最重者,入院和出院4周的hsCRP分别为91.90mg/L和46.90mg/L。结论:彩色多普勒超声能较静脉造影更早、更准确反映DVT的实际病情,可作为指导处理DVT的可靠根据。hsCRP随DVT病情加重升高,随病情减轻而下降,可作为DVT和PTS的生物观察指标。Objective： To evaluate the superiority in diagnosing DVT between venography and duplex ultrasound, and the effectiveness of C-reactive protein （CRP） as a biomarker. Methods： Firstly,the iliac - femoral vein of the dog left hind leg was isolated,and then, the thrombosis model was established by infusing the thrombin after breaking endangium.The recanalization of thrombosis was assessed by duplex ultrasound and venography, and the expression of serum hsCRP was also examined. From 2006 to 2008, 77 patients with acute DVT proximal to the knee joint were admitted. The interval between the onset of DVT and admission was 1-21 days. They were treated mainly with urokinase and low molecular weight heparin for 2 weeks. The assessment of each patient including clinical manifestation, venography, duplex ultrasound and serum highly sensitive C-reactive protein （hsCRP） were performed immediately after admission and 4 weeks after discharge. Results： After medical therapy for 2 weeks, the clinical features prominently subsided in 49 patients, improved in 23 and didn＇t ameliorate in 5.4 weeks after discharge, venography showed clot regression in 15 patients; while in the remaining 62 patients the occluded venous lumen were not visualized, duplex ultrasound showed partial lysis of the thrombosis. At admission, the hsCRP was 28.91 ± 29.4mg/L, and it dropped to 8.13 ± 12.7mg/L at 4 weeks after discharge. Conclusion：Duplex ultrasound was effective to assess DVT. The hsCRP was positively related to the severity of DVT.

关 键 词：深静脉血栓 彩色多普勒超声 静脉造影术 C-反应蛋白 

分 类 号：R543.6[医药卫生—心血管疾病]