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残余血栓对静脉血栓栓塞症预后的影响研究进展
朱杰
樊静雯
许小毛
作者及单位信息
·
DOI： 10.3760/cma.j.issn.1001-0939.2019.02.007
Prognostic significance of residual thrombus in patients with venous thromboembolism: a review
Zhu Jie
Fan Jingwen
Xu Xiaomao
Authors Info & Affiliations
Zhu Jie
Fan Jingwen
Xu Xiaomao
·
DOI： 10.3760/cma.j.issn.1001-0939.2019.02.007
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摘要

残余血栓（residual thrombosis）是指VTE患者经3或6个月常规抗凝治疗后，不能被自身纤溶机制完全溶解且发生部分机化或纤维化的血栓。目前用于评估残余血栓的方法主要包括下肢加压超声、肺通气-灌注扫描、计算机断层扫描肺动脉造影等。已有研究证实残余血栓是导致VTE并发症、复发及死亡的高危因素。因此，临床医生应该重视残余血栓，在急性期就开始正确指导患者用药及个体化治疗，根据评估结果适当调整延展期抗凝疗程，以减少残余血栓的形成，进而减少VTE的相关并发症，改善患者长期预后。

引用本文

朱杰,樊静雯,许小毛. 残余血栓对静脉血栓栓塞症预后的影响研究进展[J]. 中华结核和呼吸杂志,2019,42(2)：114-118.

DOI:10.3760/cma.j.issn.1001-0939.2019.02.007

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静脉血栓栓塞症（venous thromboembolism，VTE）是一种临床上较为常见的疾病，包括肺血栓栓塞症（pulmonary embolism，PE）和下肢深静脉血栓形成（deep vein thrombosis，DVT）。该病在全球具有很高的发病率 [ 1 ]。据文献报道，在欧盟的6个主要国家，每年症状性VTE的发生例数超过100万例，其中34%的患者可表现为突发致死性PE [ 2 ]。在我国，近年来诊断为VTE的病例数也在逐年迅速增加，绝大部分医院诊断的VTE例数较20年前有10~30倍的增长 [ 3 ]。目前，VTE的病死率和复发率仍然很高，部分患者的预后情况依然严峻复杂。近期研究数据显示，PE患者7 d全因死亡率为1.9%~2.9%，30 d全因病死率为4.9%~6.6%。同时VTE患者6个月的复发率约4.3%，1年复发率约7.2%，10年复发率约35.4% [ 4 , 5 ]。根据当前学者的研究来看，引起VTE并发症和复发的因素有很多，其中抗凝治疗后的残余血栓（residual thrombosis）已被认为是导致VTE并发症发生、复发及死亡的高危因素 [ 6 , 7 , 8 ]。因此评估抗凝治疗后的残余血栓有助于分析VTE患者的预后，从而更加全面地把握患者状况。同时，评估残余血栓对于今后VTE预防和治疗也具有重要的参考价值，可进一步降低患者VTE复发和死亡风险。故本文旨在综述残余血栓对静脉血栓栓塞症预后影响，并对目前国内外相关研究进展进行总结。
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备注信息
A
许小毛，Email： mocdef.3ab61oamoaixux
B
所有作者均声明不存在利益冲突
C
国家重点研发计划 (2016YFC0905602)
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