深部静脈血栓症患者における下肢静脈径と肺動脈血栓塞栓症との関連

Yuki Okamura; 岡村優樹; Masatomo Tomizono; 富園正朋; Katuyuki Umebashi; 梅橋功征; Shinya Motoyama; 本山眞弥

doi:10.11272/jss.280

深部静脈血栓症患者における下肢静脈径と肺動脈血栓塞栓症との関連Association Between Lower Limbs Vein Diameter and Pulmonary Thromboembolism of the Deep Vein Thrombosis

岡村優樹，富園正朋，梅橋功征，本山眞弥Yuki Okamura, Masatomo Tomizono, Katuyuki Umebashi, Shinya Motoyama

国立病院機構鹿児島医療センター臨床検査科Department of Clinical Laboratory, National Hospital Organization Kagoshima Medical Center

受付日：2018年9月6日Received: September 6, 2018

受理日：2019年6月14日Accepted: June 14, 2019

発行日：2019年10月1日Published: October 1, 2019

目的：深部静脈血栓症（Deep Vein Thrombosis: DVT）は，静脈の内皮障害，血液の凝固亢進，静脈の血流停滞によって特に下肢静脈に血栓を形成する．形成された静脈血栓が，肺動脈を閉塞することにより，呼吸循環障害や突然死の原因となる肺動脈血栓塞栓症（Pulmonary thromboembolism: PTE）を併発する．下肢静脈径とPTEとの関連は報告が少ない．本研究では，DVT患者の下肢静脈径とPTE発症との関連について研究した．

対象と方法：2013年1月～2017年4月までに，下肢静脈超音波検査にてDVTを認めた患者を対象とし，PTE発症群と非発症群の両側総大腿・大腿・膝窩・ヒラメ静脈の短軸像での下肢静脈径を比較した．片側DVTにおける下肢静脈径の左右差の程度を表すために，下肢静脈径拡張比率（拡張径／非拡張径）を求めた．

結果と考察：対象はDVT患者75名（平均年齢71.2±14.9歳，女性42名）だった．PTE発症群は非発症群と比較して中枢側の静脈径が拡張していたRt.CFV (8.7 vs 6.7 mm, p＝0.01), Rt.FV (7.4 vs 6.0 mm, p＝0.01), Rt.PopV (7.7 vs 6.4 mm, p＝0.02), Lt.CFV (11.1 vs 7.1 mm, p＜0.001), Lt.FV (9.1 vs 6.0 mm, p＜0.001), Lt.PopV（8.6 vs 6.6 mm, p＝0.01）．両側SVに関しては有意差を認めなかった（p＝0.35, p＝0.61）．また，PTE発症群と非発症群で有意差を認めた中枢側の下肢静脈径において，片側DVTでの下肢静脈径拡張比率が増大するとPTE発症が増加した（CFV, p＜0.019）．

結論：DVT患者の下肢静脈超音波検査における仰臥位での中枢側下肢静脈径拡張と下肢静脈径拡張比率の増大は，PTE発症の予測因子となり得る可能性が示唆された．

Purpose: Deep Vein Thrombosis (DVT) forms a clot in lower limbs vein. DVT is a risk factor for Pulmonary thromboembolism (PTE). DVT is related to lower limbs vein diameter, but little is known about the clinical significance of lower limbs vein diameter of DVT patients in a recumbent position for PTE onset. We investigated the relationship between lower limbs vein diameter at admission in DVT patients and PTE.

Subjects and Methods: From January, 2013 to April, 2017, we studied 75 patients who underwent DVT by lower limbs vein sonography. Both side common femoral vein, femoral vein, popliteal vein and soleal vein measured lower limbs vein diameter with a short axis image. It is excluded that a patients of lower limbs vein diameter can’t measure with a short axis image and recognized DVT after PTE by lower limbs vein sonography.

Results and Discussion: 75 patients with DVT (mean age 71.2±14.9 years, female 42) were included. PTE developed in 17 patients among 75 patients with DVT. Patients with lower limbs vein diameter of the central side of PTE group were higher than non-PTE group Rt.CFV (8.7 mm vs 6.7 mm, p＝0.01), Rt.FV (7.4 mm vs 6.0 mm, p＝0.01), Rt.PopV (7.7 mm vs 6.4 mm, p＝0.02), Lt.CFV (11.1 mm vs 7.1 mm, p＜0.001), Lt.FV (9.1 mm vs 6.0 mm, p＜0.001), Lt.PopV (8.6 mm vs 6.6 mm, p＝0.01). Lower limbs vein diameter of the peripheral side didn’t have the difference in PTE group and non-PTE group Rt.SV (p＝0.35). Lt.SV (p＝0.61). Central side vein diameter expansion ratio was increased in the PTE onset (CFV, p＜0.019).

Conclusion: It is suggested that the measurement of the lower limbs vein diameter and vein diameter expansion ratio with the supine postures of the DVT patient is useful for the predictive factor of PTE onset.

Key words: deep vein thrombosis; pulmonary thromboembolism; lower limbs vein diameter; vein diameter expansion ratio

超音波検査技術

研究Research Paper

深部静脈血栓症患者における下肢静脈径と肺動脈血栓塞栓症との関連Association Between Lower Limbs Vein Diameter and Pulmonary Thromboembolism of the Deep Vein Thrombosis