Asymptomatic deep venous thrombosis identified on routine screening in patients with hospitalized neurological diseases
Asymptomatic deep venous thrombosis identified on routine screening in patients with hospitalized neurological diseases
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DOI：
10.1016/j.jocn.2022.06.002
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发表时间：
2022-06-07
影响因子：
2
通讯作者：
Ueda, Mitsuharu
中科院分区：
文献类型：
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作者：
Nakajima, Makoto;Watari, Mari;Ueda, Mitsuharu
目的：神经系统疾病患者发生深静脉血栓形成(DVT)的风险很高。我们调查了在住院期间发现深静脉血栓的神经疾病患者的患病率和临床背景。方法：前瞻性登记因神经疾病住院的连续患者。对有DVT风险的患者进行双功能下肢静脉超声检查。结果：在研究期间，785例患者中有192例接受了双功能超声检查。确诊的DVT患者34例(18%，年龄63+/-17岁)。3例患者的深静脉血栓位于月国静脉或股静脉，其余患者位于膝盖以下；所有的深静脉血栓均无症状。DVT多见于系统性脉管炎患者，其次为脱髓鞘疾病。在DVT患者中，D-二聚体水平的中位数为2.1微克/毫升。多因素Logistic回归分析显示，女性(优势比，95%可信区间)3.2，1.2~8.4，仰卧位或坐位48 h(5.3，1.8~15.0)，D-二聚体水平=2.0µg/mL(6.2，2.3~16.4)，白细胞计数=7,600(4.2，1.6~11.3)是首次超声检查发现深静脉血栓的独立预测因素。胸部CT发现DVT 1例，无症状肺栓塞2例，两者均1例。结论：DVT在神经系统疾病患者中并不罕见。临床医生应该注意日常活动减少、D-二聚体水平或血细胞计数升高的住院神经疾病患者的亚临床DVT，尤其是在女性。
Purpose: Patients with neurological diseases are potentially at high risk for developing deep venous thrombosis (DVT). We sought the prevalence and clinical background of patients with neurological diseases in whom DVT was detected during hospitalization.Methods: Consecutive patients admitted due to neurological diseases were prospectively registered. Those who were at risk for DVT were screened using venous duplex ultrasonography of the lower extremities. Predictors for DVT detection were analyzed.Results: During the study period, 192 of 785 patients received duplex ultrasonography. There were 34 patients with DVT identified (18%, age 63 +/- 17 years). Three patients had DVT in the popliteal or femoral vein and the others had below the knee; all of the DVT were asymptomatic. DVT was observed most frequently in patients with systemic vasculitis, followed by demyelinating disease. In patients with DVT, the median D-dimer level was 2.1 mu g/mL. On multiple logistic regression analysis, female ([odds ratio, 95% confidence interval] 3.2, 1.2-8.4), supine or sitting position for > 48 h (5.3, 1.8-15.0), D-dimer level >= 2.0 mu g/mL (6.2, 2.3-16.4), and white blood cell count >= 7,600 (4.2, 1.6-11.3) were independent predictors of DVT detection at the first screening ultra-sonography. DVT was detected in 1, asymptomatic pulmonary embolism was detected in 2, and both in 1 on chest computed tomography.Conclusion: DVT is not rare in patients with neurological diseases. Clinicians should be mindful of subclinical DVT in hospitalized neurological disease patients with decreased daily activity and elevated D-dimer levels or blood cell counts, especially in women.