CAJ | 학술논문

目的:探讨致死性肺动脉血栓栓塞的高危因素及其临床病理特点,为临床预防及治疗致死性肺栓塞提供帮助.方法:对北京大学基础医学院病理学系2002年1月1日至2008年9月30日完成的162例成人医疗纠纷尸检病例进行回顾性分析,用限制性长度多态性(RFLP)的方法对致死性肺栓塞病例(21例)及随机对照成人病例(6例)进行F Ⅴ(factor Ⅴ)Leiden突变和FⅡ(factor Ⅱ)C20210A突变检测.结果:有21例致死性肺动脉血栓栓塞病例,占病例总数的12.96%(21/162).每例均至少存在1项已知的高危因素,多数病例存在2项以上的高危因素.主要的获得性高危因素包括:手术、创伤骨折、恶性肿瘤、妊娠及产褥期、老年人、高血压、糖尿病、感染等.21例致死性肺栓塞病例及6例对照病例均未检测出FⅤ Leiden突变与F Ⅱ G20210A突变.21例患者中,只有6例生前进行了D-二聚体检查,6例均明显升高;只有1例患者使用药物进行预防性抗凝.结论:致死性肺动脉血栓栓塞是临床科室尤其是手术科室引起纠纷的重要原因.中国人发生致死性肺栓塞主要与创伤骨折、手术等获得性因素有关,遗传性因素FⅤ Leiden突变和FⅡ G20210A突变不是中国人发生致死性肺栓塞的主要原因.对存在肺栓塞高危因素(尤其是创伤骨折及手术)的患者,合理评估患者的危险因素,做好预防性措施,并尽可能的早期诊断与处理或可减少致死性肺栓塞的发生.
목적:탐토치사성폐동맥혈전전새적고위인소급기림상병리특점,위림상예방급치료치사성폐전새제공방조.방법:대북경대학기출의학원병이학계2002년1월1일지2008년9월30일완성적162례성인의료규분시검병례진행회고성분석,용한제성장도다태성(RFLP)적방법대치사성폐전새병례(21례)급수궤대조성인병례(6례)진행F Ⅴ(factor Ⅴ)Leiden돌변화FⅡ(factor Ⅱ)C20210A돌변검측.결과:유21례치사성폐동맥혈전전새병례,점병례총수적12.96%(21/162).매례균지소존재1항이지적고위인소,다수병례존재2항이상적고위인소.주요적획득성고위인소포괄:수술、창상골절、악성종류、임신급산욕기、노년인、고혈압、당뇨병、감염등.21례치사성폐전새병례급6례대조병례균미검측출FⅤ Leiden돌변여F Ⅱ G20210A돌변.21례환자중,지유6례생전진행료D-이취체검사,6례균명현승고;지유1례환자사용약물진행예방성항응.결론:치사성폐동맥혈전전새시림상과실우기시수술과실인기규분적중요원인.중국인발생치사성폐전새주요여창상골절、수술등획득성인소유관,유전성인소FⅤ Leiden돌변화FⅡ G20210A돌변불시중국인발생치사성폐전새적주요원인.대존재폐전새고위인소(우기시창상골절급수술)적환자,합리평고환자적위험인소,주호예방성조시,병진가능적조기진단여처리혹가감소치사성폐전새적발생.
Objective: To explore the clinical and pathological characteristics of fatal pulmonary thromboembolism, especially the contribution of acquired and genetic risk factors of fatal pulmonary thromboembolism, so as to provide some useful information for its clinical prevention and treatment. Methods:The medical dispute autopsy cases performed at the Department of Pathology, School of Basic Medical Sciences, Peking University from January 1, 2002 to September 30, 2008 were retrospectively reviewed.FⅤ ( factor Ⅴ ) Leiden mutation and F Ⅱ ( factor Ⅱ ) G20210A mutation were analyzed by using methods of PCR and restriction fragment length polymorphism (RFLP) in fatal pulmonary embolism cases and random selected control cases of adult autopsy. Results: There were 21 patients who died from fatal pulmonary thromboembolism, accounting for 12.96% (21/162) of adult autopsy cases. In these cases,there was at least one of the known risk factors in each case and more than two risk factors could be found in most cases. The acquired risk factors, such as surgery, trauma and fractures, cancer, pregnancy and puerperium, the elderly, hypertension, diabetes, infections, could be found in these patients. FⅤ Leiden mutation and F Ⅱ G20210A mutation were not detected in any of the 21 cases of fatal pulmonary thromboembolism cases and six control cases. Of all the 21 cases, quantitative D-dimer measurement was performed only in six patients and D-dime level in these six samples was all significantly increased. According to the records, there was only 1 patient treated by preventive anticoagulants in the 21 patients.Conclusion: Fatal pulmonary thromboembolism is an important reason for medical dispute. Fractures and trauma, surgery and other acquired factors are the main reasons for fatal pulmonary embolism in Chinese.Genetic factors (FV Leiden and FⅡ G20210A mutations) are not the reason for Chinese to suffer from fatal pulmonary thromboembolism. Assessment of risk factors ( especially traumatic fractures and surgical intervention) of pulmonary thromboembolism may play an important role in taking appropriate preventive procedures, early diagnosis and reasonable treatment to reduce its mortality.