肿瘤诱发获得性凝血因子Ⅴ缺乏1例并文献复习  

A case report of acquired factor Ⅴ deficiency caused by tumor and literature review

作　　者：吴丹阳 王晓雪[1] 潘登[1] 李艳[1] WU Danyang;WANG Xiaoxue;PAN Deng;LI Yan(Department of Hematology,the First Affiliated Hospital of China Medical University,Liaoning Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院血液科,辽宁沈阳110001

出　　处：《现代肿瘤医学》2021年第22期4002-4005,共4页Journal of Modern Oncology

摘　　要：目的:研究肿瘤诱发的获得性凝血因子Ⅴ缺乏症(acquired factor V deficiency, AFVD)临床表现特点,探讨肿瘤诱发的AFVD的治疗选择。方法:报道1例肿瘤诱发AFVD患者的临床特征、实验室检查指标、诊治经过并进行相关的文献复习及讨论。结果:老年男性,临床表现为黑便,无遗传性凝血因子缺乏病史及家族史。实验室检查提示凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)显著延长,凝血因子V活性(Factor V∶C)降低,Ⅴ因子抑制物水平升高。PET/CT:结肠及回肠末段代谢增高,提示肿瘤性疾病。对症输注新鲜冰冻血浆(FFP)后疗效欠佳。应用糖皮质激素治疗后出现血压明显升高,继而出现急性硬膜下出血,紧急给予Ⅶ因子抢救,最终放弃治疗出院,院外患者死亡。结论:获得性凝血因子Ⅴ抑制物所致的凝血障碍是一种少见疾病,预后与患者基础疾病相关。对于老年患者需注意除外肿瘤性疾病继发的AFVD以及糖皮质激素治疗的副作用。Objective:To study the clinical characteristics of acquired factor Ⅴ deficiency(AFVD) caused by tumor and the treatment options.Methods:This paper reported the clinical characteristics, laboratory tests, diagnosis and treatment of a patient with AFVD caused by tumor, and reviewed the relevant literatures.Results:A 68-year-old man presented to our hospital with gastrointestinal bleeding and melena, with no history of hereditary coagulation factor deficiency.Laboratory examination showed that prothrombin time(PT) and activated partial thromboplastin time(APTT) were significantly prolonged, factor V coagulant activity(Factor Ⅴ∶C) decreased, and the level of factor Ⅴ inhibitor increased.PET/CT showed high SUV of colon and ileum exhibiting tumor disease.The infusion of fresh frozen plasma(FFP) couldn’ t relieve the bleeding symptoms.After the application of glucocorticoid treatment, the blood pressure of the patient increased significantly, and then acute subdural hemorrhage happened.Then factor Ⅶ was given immediately for salvage, but finally they gave up further treatment.Conclusion:Coagulation disorder caused by acquired factor Ⅴ inhibitor is a rare disease.The prognosis is related to the basic diseases of patient.We should screen the tumor diseases of elderly patients with AFVD and pay attention to the side effects of glucocorticoid.

关 键 词：获得性凝血因子Ⅴ缺乏症 肿瘤 凝血因子抑制物 糖皮质激素 

分 类 号：R733[医药卫生—肿瘤]