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Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi 04/2013; 34(4):355-8.
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ABSTRACT: Hemophagocytic lymphohistiocytosis (HLH) is a lifethreatening disorder due to hyperinflammation resulting in infiltration of different organs with extensive hemophagocytosis. Severe coagulopathy was one of the main reasons for death in HLH. Over secretion of plasminogen activator by activated macrophages leads to hyperfibrinolysis. We reported a 36-year-old woman who was diagnosed as HLH probably secondary to lymphoma. Massive bleeding from gut and retroperitoneal area were not able to be controlled by conventional hemostatic treatments. This patient received one dose recombinant activated factor VII (rFVIIa) 3.6 mg (70 μg/kg). Hemostatic effect was achieved in 0.5 hour and lasted 24 hours. Prothrombin time (PT) and activated partial thromboplastin time (APTT) were quickly corrected to normal ranges. Fibrinogen level elevated from 0.5 g/L before using rFVIIa to 1.8 g/L 20 hours after. Although dexamethasone and etopside were administrated to treat HLH, this patient died from septic shock after persistent neutropenia. This suggests that rFVIIa may be effective in the management of intractable hemorrhage in patients with HLH.
Chinese medical journal 10/2011; 124(19):3189-91. · 0.86 Impact Factor
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Bing Han,
Si-yi Yan,
Nong Zou,
Wei Zhang,
Jian Li,
Ming-hui Duan,
Li Jiao,
Jun-ling Zhuang, Shu-jie Wang,
Dao-bin Zhou,
Tie-nan Zhu,
Ying Xu,
Yong-qiang Zhao,
Ti Shen
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ABSTRACT: To evaluate the efficacy of porcine anti-human lymphocyte globulin (P-ALG) plus cyclosporine A (CsA) therapy for severe aplastic anemia (SAA).
Forty-eight SAA patients (31 males, 17 females) including 17 very severe aplastic anemias (vSAA) were treated with ALG plus CsA between 1999 to 2009 in our hospital and the outcomes were analyzed retrospectively for early mortality, response rate and quality, survival rate, toxicity and complications.
The median age was 28 (13 - 64) years. The interval from diagnosis to treatment was 45 days. The median neutrophil count at diagnosis was 0.178 × 10(9)/L. Overall response was 83.3% (54.2% complete, 29.2% partial) with a median time of 90 (23 - 380) days. 10.4% died of infection within 30 days mainly of fungi infection. Only 1 patient relapsed 2 years after treatment. No clonal disease was found. The 1.5-year survival rate was 87.5%. vSAAs had less response, higher early mortality and less survival (64.7%, 29.4% and 51.8%, respectively) compared to that of SAA (93.5%, 0, 100%, respectively, P < 0.05). Grouped patients with different age, gender, intervals between diagnosis and treatment and pre-existing infections had similar response. The main side effects were fever and skin rash (52.1%), serum sickness (16.7%), impaired liver function (60.4%) and hemorrhage (2.1%). No treatment-related mortality was found.
P-ALG plus CsA is an ideal and well tolerated treatment for SAA but not for vSAA.
Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi 04/2011; 32(4):241-4.
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Ming Yang,
Feng-Dan Wang,
Bing Han, Shu-Jie Wang,
Dao-Bin Zhou,
Hui Pan,
Yong-Qiang Zhao,
Quan-Cai Cui,
Li Ma,
Wee-Joo Chng,
Ti Shen
Acta Haematologica 01/2011; 125(3):125-9. · 1.35 Impact Factor
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ABSTRACT: This study was to evaluate the role of reticulated platelets (RP) assay in the distinguishing the different causes of thrombocytopenia. The RP and immature platelet fraction (IPF) were stained by a nucleic acid-specific dye oxazine, and assayed by XE-2100 blood cell counter with an upgraded software in the reticulocyte/optical platelet channel. RP and IPF were measured in 137 thrombocytopenic patients and 187 normal controls. The results showed that the mean IPF was 1.07% in normal controls, and 10.28% in 109 patients with immune thrombocytopenia (p<0.01), RP absolute value in ITP group was higher than that in control group, there was significant difference between them (p=0.036). The mean IPF was 10.47% in patients with primary immune thrombocytopenia (PITP), and 9.45% in patients with secondary ITP (SITP). There was no significant difference of IPF between PITP and SITP group (p=0.635), but IPF in these 2 groups both were significantly higher than the normal controls. The mean IPF in 28 thrombocytopenic patients with hypocellular marrow was 2.37%. There was no difference of IPF between thrombocytopenic patients with hypocellular marrow and the normal controls (p=0.252), but the absolute counts of RP in the former was significantly lower than in the latter (p<0.05). The IPF cut-off for a diagnosis of thrombocytopenia with hypercellular marrow was 2.45%, the sensitivity was 92.7% and specificity 94.1%. It is concluded that the whole-blood IPF measurement by XE-2100 blood cell counter is an useful screening test to differentiate patients with thrombocytopenia of different causes. An IPF above 2.45% has both a high sensitivity and specificity for a diagnosis of thrombocytopenia with a hypercellular marrow.
Zhongguo shi yan xue ye xue za zhi / Zhongguo bing li sheng li xue hui = Journal of experimental hematology / Chinese Association of Pathophysiology 04/2010; 18(2):482-5.
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Plastic and reconstructive surgery 12/2009; 124(6):440e. · 2.74 Impact Factor
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Jian-Xiang Wang,
Xiao-Jun Huang,
De-Pei Wu,
Jian-da Hu,
Ting Liu,
Yu Hu,
Fan-Yi Meng,
Xie-Qun Chen,
Ming Hou,
Yan Li, [......],
Ai-Ning Sun,
Ting-Bo Liu,
Huan-Ling Zhu,
Tao Guo,
Dan Xu,
Chun-Yan Ji,
Xiao-Yi Lü,
Li Jiao,
Xian-Min Song,
Hong-Hui Huang
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ABSTRACT: To explore demographic characteristics, current diagnosis and treatment patterns of chronic myelogenous leukemia (CML) patients in China.
Data of hospitalized CML patients in 2005 whole year and outpatient information (July 1 through September 30, 2006) from 15 hospitals throughout China were analyzed.
A total of 1824 CML cases were analyzed, including 722 inpatients and 1102 outpatients. The male/female ratio was 1.78:1. The median age at diagnosis was 40.02 (2.45 - 83.29) years old, 90.41% of the patients were diagnosed at chronic phase. Proportion of accelerated phase or blast crisis patients increased to 21.66% during study period. 93.20% of the patients received blood routine and bone marrow morphologic examination at diagnosis and in monitoring; 70.29% were performed cytogenetic analysis and 51.54% performed molecular measurement in addition. The most common therapy for CML treatment was hydroxycarbamide. The proportion of patients treated with imatinib and interferon was 37.45% and 25.55%, respectively. Of 722 inpatients, 164 (22.72%) received hemotopoietic stem cell transplantation (HSCT). The proportions of accelerated phase and blast crisis patients treated with imatinib were 48.28% and 48.42%, respectively, being significantly higher than that of chronic phase patients (35.9%) (P < 0.05). The mean imatinib dosage administered in the three phases patients did not differ significantly. Imatinib resistance rates were 6.87% and 16.28% for outpatient and inpatient, respectively. In the outpatient group, the primary resistance to imatinib occurred comparably to the secondary resistance (68.75%), while primary resistance was predominant in inpatient group (65.71%). The intolerance rates of imatinib for outpatient and inpatient were 3.21%, 11.63%, respectively. The majority of patients treated with imatinb were not monitored in time: 63.38% patients evaluated hematologic response after 3 months of treatment, proportions of patients received cytogenetic examination after 6 months and 12 months of treatment were 41.41% and 27.35%, respectively. Mean cost for HSCT was 213 092 +/- 125 890 RMB.
CML in China tends to afflict younger population than in Western countries. Most patients were diagnosed in the chronic phase. Due to restriction of financial support, only one third of CML patients were treated with imatinib, and the majority of the treated were not monitored in time. Clinicians should pay attention to resistance and intolerance to imatinib treatment in accelerated phase or blast crisis patients.
Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi 11/2009; 30(11):721-5.
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ABSTRACT: To explore the methylation of CpG islands in promoter of eye absent gene 1 (EYA1) in microtia.
The methylation of CpG islands in EYA1 gene in 64 microtias and 36 healthy controls were measured using the technique of matrix-assisted laser desorption/ionization-time of flight.
The methylation of CpG_Unit3 and CpG_Unit5 of EYA1 gene in microtia were 0.09258 +/- 0.033846 and 0.0922 +/- 0.02379, respectively, which were significantly lower than those in control.
Hypomethylation in microtia may be related to the pathogenesis of the disease.
Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi = Chinese journal of plastic surgery 11/2009; 25(6):436-9.
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ABSTRACT: To investigate the effects of arsenic pentaoxide (As2O5) on the proliferation and apoptosis of endothelial cells and compare the effect of As2O5 and arsenic trioxide (As2O3) in vitro.
Human umbilical vein endothelial cells (HUVEC) were incubated with or without As2O5 or As2O3 for a certain period. The proliferation profile of HUVEC was determined by methyl thiazolyl tetrazolium (MTT) method. The apoptosis of HUVEC was detected by microscopy and flow cytometry (FCM).
As shown by MTT assay, the viabilities of HUVEC were (72.5 +/- 13.8)%, (52.9 +/- 6.2)%, (15.0 +/- 12.8)%, and (13.8 +/- 13.2)%, respectively, in 0.5, 1.0, 5.0, and 10.0 mg/L As2O5 groups, of which the viabilities of HUVEC at 1.0, 5.0, and 10.0 mg/L of As2O5 were significantly lower than controls (P = 0.006, 0.007, and 0.008); however, the viability was not significantly different between 5.0 and 10.0 mg/L As2O5 groups (P = 0.119). In 1.0 mg/L As2O5 group, the cell viabilities were (88.4 +/- 6.3)%, (53.1 +/- 8.8)%, (30.7 +/- 7.9)%, and (16.3 +/- 4.6)%, respectively, at 24, 48, 72, and 96 h, of which the cell viabilities at 48, 72, and 96 h were significantly lower than controls (P = 0.042, 0.025, and 0.012). As2O5-induced apoptosis of HUVEC was observed by phase contrast microscope and flow cytometry with Annexin V/PI staining. After 48 hours of incubation, the IC50s of As2O5 and As2O3 were 1.1 and 0.3 mg/L, respectively.
As2O5 can inhibit the proliferation of HUVEC and the minimum effective concentration is 1 mg/L. Apoptosis is the main way that As2O5 induces the death of HUVEC. The inhibitory effect of As2O5 on HUVEC is weaker than that of As2O3.
Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 10/2009; 31(5):538-41.
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ABSTRACT: To compare the sensitivity and practicability of modified Bethesda assay and Nijmegen assay in detecting factor VIII (FVIII) inhibitor.
Modified Bethesda assay and Nijmegen assay were used to screen FVIII inhibitors in 237 patients with hemophilia A. The buffer plus universal coagulation reference plasma (UCRP) was used to establish a standard curve for FVIII: C assay in modified Bethesda method, instead of Nijmegen plasma plus FVIII deficiency plasma in Nijmegen method. The cutoff value for positive FVIII inhibitors is > or = 0.6 BU/ml.
The positive rate of FVIII inhibitors was 5.5% (n = 13) when using modified Bethesda assay and was 8.4% (n = 20) when using Nijmegen assay (P > 0.05).
Modified standard Bethesda assay is a convenient and feasible method for detecting FVIII inhibitors.
Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 10/2009; 31(5):551-4.
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Li Jiao, Shu-Jie Wang,
Jun-Ling Zhuang,
Yong-Qiang Zhao,
Dao-Bin Zhou,
Ying Xu,
Bing Han,
Wei Zhang,
Ming-Hui Duan,
Nong Zou,
Tie-Nan Zhu,
Ti Shen
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ABSTRACT: To compare the efficacy and adverse effects between arsenic trioxide (ATO) and all-trans retinoic acid (ATRA) in patients with acute promyelocytic leukemia (APL).
The clinical data of 71 patients with newly diagnosed APL were retrospectively analyzed. Two groups were classified according to the induction regimens, namely ATO group (n = 41) and ATRA group (n = 30). The complete remission (CR) rate and the time to CR were compared between these two groups.
The CR rate was 97.5% in ATO group and 93.3% in ATRA group (P > 0.05). The median time to CR was 29 days (21-45 days) in ATO group, which was significantly shorter than 38.5 days (24-63 days) in ATRA group (P < 0.001). Retinoic acid syndrome occurred in 52.9% of patients treated with ATRA, which affected the further use of ATRA.
Both ATO and ATRA have high response rates for newly diagnosed patients with APL. Compared with ATRA, ATO induction therapy has shorter time to achieve CR and less adverse effects, and therefore may be the first-line therapy for APL.
Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 10/2009; 31(5):555-8.
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Hai-Yan Xie,
Dao-Bin Zhou, Shu-Jie Wang,
Bing Han,
Wei Zhang,
Li Jiao,
Jian Li,
Yong-Ji Wu,
Yong-Qiang Zhao,
Ti Shen,
Tao Xu
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ABSTRACT: To explore the feasible age limits in Chinese elderly patients with non-Hodgkin's lymphoma (NHL).
The clinical data of 507 patients with NHL who were admitted to Peking Union Medical College Hospital (PUMCH) from January 1990 to December 2007 were retrospectively analyzed. They were further followed up by reviewing medical records or by phone. The deadline of follow-up was October 2008.
The 5-year/8-year overall survival (OS) rates were 64.6%/45.7%, 53.0%/ 44.1%, 32.8%/17.5%, 40.0%/22.8%, and 19.8%/0, respectively, in patients aged < 60 years, 60-64 years, 65-69 years, 70-74 years, and > or = 75 years. The OS rate was significantly different between patients aged > or = 75 years and other age groups, and between patients aged 65-70 years and patients younger than 60 years (P < 0.05). Only age, serum albumin, and hemoglobin affected the survival status in elderly NHL patients.
Sixty-five years can be regarded as the age limit in Chinese NHL patients.
Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 10/2009; 31(5):559-63.
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Li Jiao,
Dao-Bin Zhou, Shu-Jie Wang,
Wei Zhang,
Ming-Hui Duan,
Jian Li,
Bing Han,
Ying Xu,
Yong-Qiang Zhao,
Ti Shen,
Qiang Wang,
Min Ye
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ABSTRACT: To explore the clinical value of blood concentration monitoring during high-dose methotrexate (MTX) treatment.
High-dose MTX (1.5-9.0 g) was infused to 105 patients with acute lymphoblastic leukemia or lymphoma, and then the blood MTX concentration was measured by fluorescence polarization immune assay (FPIA) 44 hours after the start of administration. The procedure was repeated every 6-12 hours until the concentration was less than 0.1 micromol/L.
Forty-four hours after the start of administration, the blood MTX concentration (C(MTX/44h)) was > or = 5 micromol/L in 6 patients (2.8%) and was between 1 and 5 micromol/L in 23 patients (10.6%). C(MTX/44h) > or = 1 micromol/L was more common in patients received 5.0 g MTX. No severe adverse event was observed in all patients.
Blood MTX concentration is different after high-dose MTX treatment due to individual metabolic differences, and therefore it is clinically important to monitor blood concentration of MTX. Elimination delay is more common in patients receive 5.0 g MTX. Application of high-dose MTX therapy under the monitoring of blood MTX concentration is safe and feasible.
Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 10/2009; 31(5):564-6.
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ABSTRACT: To analyze the clinical features and prognosis of patients with Castleman's disease (CD).
Clinical and pathological data of 49 patients with CD diagnosed in Peking Union Medical College Hospital from January 1990 to December 2007 were retrospectively analyzed.
In patients with unicentric CD (UCD), hyaline vascular type had the highest percentage (88.2%, 15/17), which was significantly higher than that of either plasma cell type (5.9%, 1/17) or mixed cell type (5.9%, 1/17) (P < 0.05). In patients with multicentric CD (MCD), there were no significant differences among the percentages of different histopathologic types. In contrast to patients with UCD, patients with MCD were relatively older and had more typical clinical features, more frequent complications, and more frequent abnormal laboratory results. Twenty patients with UCD achieved complete remission (CR) after surgery, and their complications also disappeared one month later. Twenty-three out of 29 patients with MCD were treated with chemotherapy; only 6 patients achieved CR and 9 achieved partial remission (PR), and the overall response rate was 65.2%. Two patients who initially did not responded to chemotherapy achieved CR after the addition of rituximab.
The clinical features of CD are multifarious and nonspecific, and diagnosis is exclusively depended on histopathology. UCD has a good prognosis after surgery, while MCD often poorly responds to chemotherapy and has a relatively poor prognosis. New drugs and clinical trials are needed to improve the outcome of MCD.
Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 10/2009; 31(5):570-4.
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Xue-Feng Sun,
Bing Han,
Jun Feng,
Dao-Bin Zhou, Shu-Jie Wang,
Ying Xu,
Jia-Lin Chen,
Li Jiao,
Wei Zhang,
Jian Li,
Ming-Hui Duan,
Tie-Nan Zhu,
Nong Zou,
Bao-Lai Hua,
Hua-Cong Cai,
Yong-Qiang Zhao
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ABSTRACT: To summarize the clinical features of invasive pulmonary fungal infection (IPFI) secondary to malignant blood diseases (MBD).
We retrospectively analyzed the clinical data of 52 patients with IPFI secondary to MBD admitted to Peking Union Medical College Hospital from January 1995 to December 2008.
The incidences of IPFI secondary to acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), non-Hodgkin's lymphoma (NHL), and aplastic anemia (AA) were 4.6%, 3.2%, 2.8%, and 2.5%, respectively. In patients with IPFI secondary to AML, 88.5% (23/26) of the patients suffered from the infections during the non-remission (NR) period (including relapse), and 11.5% (3/26) in the complete-remission (CR) period. In all the patients with IPFI secondary to malignant blood diseases, 86.5% (45/52) of MBD were neutropenic or agranulocytic, and 67.3% (35/52) had been treated with broad-spectrum antibiotics for more than 96 hours before anti-fungal therapy. The total mortality after anti-fungal therapy was 13.7% (7/51). More than half of patients with fluconazol or itraconazole as the first-line therapy had to switch to other medicines because of poor infection control.
IPFI secondary to MBD is most common in AML patients. Patients with NR of AML, neutropenia or agranulocytosis, and long-term broad-spectrum anti-biotics usage are susceptible to IPFI. Fluconazol and itraconazole have low efficacy, and other more potent anti-fungal medicines should be considered.
Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 10/2009; 31(5):575-9.
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ABSTRACT: To screen for factor VIII inhibitor in patients with hemophilia A (HA) and explore the environmental risk factors for inhibitor development.
Totally 265 patients with HA were enrolled, including 107 consecutive inpatients and outpatients in Peking Union Medical College Hospital from April 2003 to April 2007 and 158 patients newly recruited from other hospitals. FVIII: C activity was measured by one-stage coagulation assay. FVIII inhibitor was determined using Bethesda method.
In 265 HA patients, FVIII inhibitor was detected in 22 patients (8.3%). Nine of them (86.4%) were low responders (inhibitor titers < or = 5 000 BU/L), 3 (13.6%) were high responders (the titers > 5 000 BU/L). The frequency of FVIII inhibitor was 50% in the patients aged over 50 years, which was significantly higher than those in other age groups (P = 0. 000). Among 158 newly recruited patients with full clinical data, the frequency of FVIII inhibitor was 12.8% in patients who had received infusion of FVIII products for more than 12 doses on average each year, while it was 5.8% in whom the infusion doses were less than 12 (P = 0.156). The frequency of FVIII inhibitor was 28.5% in patients with a history of continuous infusion of FVIII products whereas it was only 1.6% in patients without such history (P = 0.000). In patients who exposed to multiple-branded or single-branded FVIII products, the frequencies of FVIII inhibitor were 9.3% and 3.9%, respectively (P = 0.229).
The development of factor VIII inhibitor in patients with hemophilia A may be related to the age and the history of continuous infusion of FVIII products.
Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 10/2009; 31(5):580-3.
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ABSTRACT: To explore the application of tissue expander in ear reconstruction and to deal with the complications.
50 ml kidney-shape tissue expanders were implanted subcutaneously in the mastoid area. The drainage tube was removed 3 days after operation. The suture was removed 10 days later. Since 7 days after operation, 5 ml NS was injected into the expander every time, three times a week. The total injection volume was about 60 ml. After that, the expander was maintained for one month.
From January 1992 to December 2006, 5,248 patients of microtia were treated with 6,252 expander. After the maintaining period, the expanded skin was thin and well-vascularized. The complication rate was 7.79%, including hematoma, malunion and infection.
The quantitative tissue expansion is easily manipulated with few complications. It can provide hairless, thin skin with reliable blood supply for ear reconstruction.
Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi = Chinese journal of plastic surgery 07/2009; 25(4):254-7.
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ABSTRACT: To explore the fabrication and application of three-dimensional autogenous cartilage framework in auricular reconstruction.
The process of fabrication of three-dimensional cartilage framework consisted of cartilage harvesting, carving and assembling the cartilage. The rib cartilage was harvested separately. The three-dimensional framework was composed of three main parts:the helix, the base and the pad, at different layer. The framework was fabricated according to the development of rib cartilage and contour and height of the reconstructed ear.
From January 1992 to December 2006, 5,248 patients of microtia were treated with 6,252 autogenous cartilage frameworks.
The three-dimensional framework is easily manipulated. The reconstructed ears look natural and had an erect contour. This method can effectively use the cartilage.
Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi = Chinese journal of plastic surgery 05/2009; 25(3):161-4.
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ABSTRACT: To investigate the indication and results of three methods for total ear reconstruction.
960 cases of total ear defect were treated with skin expansion and autogenous rib cartilage framework (n = 786), or skin expansion and Medpor framework (n = 150), or ear prosthesis (n = 24). The indication and results of the three methods were analysed.
Good cosmetic results were achieved with all three methods. Autogenous rib cartilage framework was suitable for patients under 30 years old with unaffected skin at mastoid region. Medpor framework was good for grown-up, especially over 30 years old, or with mild infection at mastoid region. Patients with severe skin injury at mastoid region or unwilling to accept surgery should choose ear prosthesis.
Satisfactory results can be achieved with suitable methods for total ear reconstruction.
Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi = Chinese journal of plastic surgery 08/2008; 24(4):287-90.
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ABSTRACT: To explore the frequency, clinical features and risk factors of venous thromboembolism (VTE) in hospitalized patients.
The frequency, demographic features, and acquired and inherited factors of in-patient cases of VTE in Peking union medical college hospital from 1994 to 2004 were analyzed retrospectively.
Six hundred and seventy-two patients were enrolled. Among them, male to female ratio was 1.2 and the median age was 53 (14 - 92). Five hundred and eighty (86.3%) patients were at their first diagnosis with the peak ages between 40 and 50 for men and 50 and 60 for women. More common acquired risk factors were antiphospholipid antibody syndrome (APS) (32.0%), trauma / surgery (31.1%) and malignancies (17.1%). 35.7% of the patients had multiple acquired risk factors. Before the initiation of anticoagulation therapy, the activities of protein C (PC), protein S (PS) and antithrombin (AT) were measured in 94 patients. The deficiency of these three natural anticoagulants was 44.7%. Among the anticoagulant deficiencies, PC deficiency was the commonest one (13.8%). Combined deficiency of PC and AT accounted for 10.6%. 31.6% of the 94 patients had inherited plus acquired risk factors.
Age for the first event of VTE in the men was about 10 years ahead of that in the women. The major acquired risk factors were APS, trauma/surgery and malignancies, and inherited risk factors were PC deficiency and PC + AT combined deficiencies. It seems that the coexistence of multiple risk factors plays an important role in triggering VTE.
Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi 10/2007; 28(9):579-82.
