不明原因与常见类型获得性维生素K依赖凝血因子缺乏症临床对照研究  

Clinical controlled study on unexplained and common types of acquired vitamin K-dependent coagulation factors deficiency

作　　者：罗玉娇 张广森[1] 田卫平 王业伟[1] 李吉 LUO Yu-jiao;ZHANG Guang-sen;TIAN Wei-ping;WANG Ye-wei;LI Ji(Department of Hematology,th Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院血液内科,湖南长沙410011

出　　处：《中国实用内科杂志》2024年第7期585-590,共6页Chinese Journal of Practical Internal Medicine

基　　金：湖南省自然科学基金(2022JJ30850,2024JJ9223)。

摘　　要：目的研究不明原因获得性维生素K(vitamin K,VitK)依赖凝血因子缺乏症(acquired deficiency of vitamin K dependent coagulation factors,ADVKDCF)患者临床和检测结果特点、治疗方法、转归及病因,提高该类疾病的认知和诊疗水平。方法回顾性研究2019年3月至2021年3月中南大学湘雅二医院21例不明原因及26例常见类型ADVKDCF患者临床特征、实验室检查结果和治疗方法,并跟踪其转归。结果不明原因ADVKDCF患者因出血症状就诊,可通过凝血酶原时间比部分活化凝血酶原时间更早也更延长进行ADVKDCF初步判断;以VitK依赖凝血因子活性检测或VitK治疗性诊断进行确证;另纤维蛋白原和肝功能均正常。治疗以VitK补充为主,其临床特征和转归与灭鼠药中毒相似,病情易反复。结论不明原因ADVKDCF应考虑灭鼠药中毒的可能,VitK的补充需及时、足量和足程。Objective The clinical and test characteristics,treatment methods,prognosis,and possible etiology of patients with unexplained acquired deficiency of vitamin K-dependent coagulation factors(ADVKDCF)were analyzed to improve the understanding and treatmentin the patients.Methods The clinical features,laboratory test results and treatment methods of 21 patients withunexplained ADVKDCF and 26 patients with common ADVKDCF in the Second Xiangya Hospital of Central South University from March 2019 to March 2021 were retrospctively studied,and their prognosis were tracked.Results ADVKDCF can be preliminatively determined by prothrombin time being earlier and longer than partially activated prothrombin time in patients with unexplained ADVKDCF who come to hospital due to bleeding symptoms.Then,ADVKDCF can be confirmed by vitamin K-dependent coagulation factors activity detection or vitamin K therapeutic diagnosis finally.In addition,fibrinogen and hepatic function were normal.Vitamin K supplement was the main treatment,and the clinical characteristics and prognosisof patients with unexplained ADVKDCF were like those of ADVKDCF patients caused by rodenticide poisoning.Conclusion Unexplained ADVKDCF should consider the possibility of rodenticide poisoning,and vitamin K should be supplemented in time,in sufficient amount and for sufficient duration.

关 键 词：维生素K依赖凝血因子 灭鼠药 维生素K 凝血酶原时间 Ⅶ因子 

分 类 号：R559[医药卫生—血液循环系统疾病]