炎症性肠病13例血栓并发症临床特点分析  

Analysis of clinical features of patients with inflammatory bowel disease of combined with thrombosis

作　　者：董旭暘 吕红[1] 陈轩馥 李骥[1] 李玥[1] 谭蓓[1] 舒慧君[1] 张慧敏[1] 钱家鸣[1] 杨红[1] DONG Xu- yang, LYU Hong, CHEN Xuan-fu, Lift, LI Yue, TAN Bei, SHU Hui-Jun, ZHANG Hui-min, QIAN Jia-ming, YANG Hong.(Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, Chin)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院消化科,北京100730

出　　处：《中国实用内科杂志》2018年第3期213-216,共4页Chinese Journal of Practical Internal Medicine

基　　金：国家卫生计生委公益性行业科研专项(201002020);中国医学科学院医学与健康科技创新工程(2016-I2M-3-001);国家自然科学基金(81570505);国家科技部973计划(2015CB943203)

摘　　要：目的分析炎症性肠病(IBD)患者发生血栓的临床特点,提高对这部分疾病人群的认识。方法检索2005年1月至2015年12月在北京协和医院住院诊治的IBD患者,筛选出其中明确出现血栓事件的患者进行回顾性研究,以1∶5选取同时期就诊、相同疾病分型、性别、年龄相匹配的无血栓事件IBD患者连续入组作为对照组,记录一般情况、IBD的分型及活动度、血栓事件的相关症状、发生部位、诱因、治疗及转归,并进行比较分析。结果共检索到IBD患者1521例,出现血栓事件者13例,血栓事件的总体发生率为0.85%。其中溃疡性结肠炎(UC)和克罗恩病(CD)患者中血栓事件发生率分别为0.93%和0.76%。血栓组男6例,女7例;平均年龄(44.3±10.7)岁。76.9%的患者为下肢深静脉血栓,表现为下肢非对称性水肿。1例CD患者出现下肢动脉血栓,表现为下肢坏疽。血栓组53.8%的患者在发现血栓时处于疾病重度活动期,与对照组相比差异有统计学意义(P=0.048)。血栓组患者中76.9%的患者在发生血栓前30 d内使用过糖皮质激素,明显高于对照组(29.2%)(P=0.003)。抗凝治疗以低分子肝素及华法林为主。2例患者治疗后血栓溶解吸收,其余患者复查均提示血栓再通。结论血栓栓塞是IBD患者的重要并发症,多出现于疾病活动期,常见部位为下肢深静脉血栓。糖皮质激素可能是常见诱因。抗凝治疗有效且相对安全。Objective To analyze the clinical features of patients with inflammatory bowel disease combined with thrombosis, and to improve the understanding about these patients. Methods We performed a cohort study in 1521 IBD patients hospitalized in Peking Union Medical College Hospital from January 2005 to December 2015. A retrospective study was carried out to screen the patients with definite first thrombosis events. Patients with thromboembolism before IBD diagnosis or cancer were excluded. The site of thrombosis, the type and activity of IBD, symptoms, risk factors, treatment and prognosis were recorded. At the same time, IBD patients without thrombotic events were consecutively selected as the control group by 1：5 ratio, who are of the same disease type, gender and age. Results A total of 13 IBD patients with thrombosis events were identified. The overall prevalence of thrombosis events was 0.85%, which was 0.93% and 0.76% respectively for ulcerative colitis （UC） and crohn＇s disease （CD）. six of 13 patients were male, with an average age of （44.3±10.7） years old. About 76.9% of the patients had deep vein thrombosis （DVT）, manifestion as asymmetrical edema in the lower extremities. A female patient with Crohn＇s disease suffered from lower extremity arterial occlusion, manifesting as lower extremity gangrene. About 53.8% of the thrombosis events occurred in an IBD flare. Glucocorticoids within 30 days before thrombus may be a related risk factor （76.9%） for the thrombosis events compared with control（29.2%, P=0.003）. The patients received anticoagulant therap）5 and the main drugs were low molecular weight heparin and warfarin. There were no visible thrombi in 2 patients after treatment. All the others showed recanalization. Conclution Thrombosis is an important complication in IBD patients, which mostly occurs during moderate-severe flares. DVT and PE are most common and unusual sites of thrombosis are rare. Corticosteroids may be a common risk factor. Anticoagulant therapy is effectiv

关 键 词：炎症性肠病 溃疡性结肠炎 克罗恩病 血栓事件 

分 类 号：R574[医药卫生—消化系统]