BMJ Best Practice

病史和查体

关键诊断因素

常见 查看所有

存在的危险因素

Key risk factors include varicose veins, thrombophilic disorders, and autoimmune diseases.

previous superficial vein thrombophlebitis (SVT), deep vein thrombosis (DVT), or pulmonary embolism (PE)

常见于 SVT 患者。

患处皮肤红斑/发红

May extend for some distance into the surrounding tissue, making the distinction from cellulitis difficult.大隐静脉浅静脉血栓性静脉炎[Figure caption and citation for the preceding image starts]: 大隐静脉浅静脉血栓性静脉炎Lucia MA, Ely EW. N Engl J Med. 2001:344;1214; 许可后使用 [Citation ends].

皮肤温度升高/发热

May extend for some distance into the surrounding tissue, making the distinction from cellulitis difficult.

受累静脉处发痛/压痛

在已有静脉曲张的患者中，可触及一个位于深层皮肤柔软的“蠕虫状”包块。

In a patient without varicose veins, a palpable, sometimes nodular, cord may have associated tenderness.

周围部位的肿胀/水肿

通常会有周围部位水肿，没有整个肢体的完全肿胀。

可触及的条索状肿物

An important sign that can distinguish SVT from other causes of leg swelling and redness. Remains palpable for several weeks to months after the initial episode of SVT.

症状的发展持续数小时至数天

典型的SVT的发作在数小时至数天，数天至数周后缓解。

伴有深静脉血栓或肺动脉栓塞的体征/症状

The prevalence of concomitant DVT varies widely in the literature from 2.6% to 65%, and, if present, it is thought to be contiguous with SVT in 50% to 75% of cases. Up to 25% of concomitant DVT may not be contiguous with the SVT and may be in the contralateral limb.[36] 深静脉血栓不连续时，深静脉血栓形成的发生机制可能与高凝状态有关。伴随有SVT和肺动脉栓塞症状的患者发生肺动脉栓塞的比例在0.5%~4%。因此，重要的是要列出肺动脉栓塞病史，例如呼吸困难、胸痛、晕厥。

其他诊断因素

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静脉曲张

在 SVT 病例中所占比例高达 70%。[15][39] 可能的局部外伤史。

近期的静脉腔内器械操作（例如硬化治疗）

继发于例如硬化治疗的 SVT 是常见的且可预期的并发症。

近期的静脉置管和静脉内药物注射

引起 SVT 的原因可以是上下肢浅表静脉置管、静脉导管给药或毒品注射的刺激。

低热

可在一些患者中出现。

色素沉着性改变

在SVT的皮肤上经常可观察到色素沉着变化。

危险因素

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静脉曲张

静脉曲张是浅静脉血栓性静脉炎的最常见病因。多达 80% 的浅静脉血栓性静脉炎患者存在下肢血管曲张，不论伴有或不伴有慢性静脉功能不全。[7][11][15]

大隐静脉发病率大约在 60%~80% 之间，而小隐静脉发病率大约在 10%~20% 之间。[16] 浅静脉血栓性静脉炎更多地发生在隐静脉分支血管，而较少发生在主干。[7]

在静脉曲张发展为浅静脉血栓性静脉炎中，静脉血液瘀滞被认为是最重要的原因。

易栓疾病

凝血异常与浅静脉血栓性静脉炎有关，特别是对于没有静脉曲张或累及大隐静脉主干的自发性浅静脉血栓性静脉炎患者。

在没有静脉曲张、自体免疫性疾病、恶性肿瘤的患者中，发生浅静脉血栓性静脉炎的风险，凝血因子 V Leiden突变提高6倍，凝血因子 II（凝血酶原）G20210A 突变提高4倍，抗凝血酶I II、蛋白 C、蛋白 S 的缺乏总体增加 13 倍风险。[17]

抗心磷脂抗的出现和凝血因子 VIII 的增多与反复发作的 SVT 风险呈正相关。[18][19]

自体免疫性疾病（例如，白塞病和血栓闭塞性脉管炎）

白塞病和血栓闭塞性脉管炎常与 SVT 相关。已提出的两种疾病的发病机制主要包含了免疫介导的内皮细胞功能障碍。

白塞病是一种自体免疫性血管炎相关的静脉血管并发症。在白塞病患者中，高达53%的患者曾患有 SVT。[20] 白塞病的诊断常需要5年以内的观察时间，在这之前很少能够诊断。

Buerger's disease is a non-atherosclerotic vascular disease also known as thromboangiitis obliterans (TAO) and is characterised by segmental vascular inflammation, vaso-occlusive phenomena, and involvement of small- and medium-sized arteries and veins of the upper and lower extremities.[21] SVT以及更多见的迁移性SVT，在血栓闭塞性脉管炎患者中发病率为27%~50%。[21]

既往 SVT 病史

It is well documented that a previous venous thrombotic episode is an important risk factor for venous thromboembolism (VTE) recurrence and that this risk is dependent on patient-specific factors such as the presence of malignancy. With regard to SVT, a prior SVT episode is also likely to be an important predictor of future SVT events, especially in patients with persistent risk factors such as varicose veins. Research has demonstrated that, after a first thrombotic episode of confirmed lower limb SVT in patients with no history of deep vein thrombosis (DVT), varicose veins, malignancy, or autoimmune disorders, up to 32% of patients developed DVT at a median elapsed interval of 4 years and 24% had recurrent episodes of SVT.[17]

女性

Most studies reveal a preponderance of females (50% to 70%),[6][7][8][10][11][12][13] possibly because of the increased prevalence of varicose veins during pregnancy.[9]

硬化疗法

Sclerotherapy, through the injection of a sclerosant or foam into varicose veins, provokes direct vessel wall damage, causing transmural wall damage, the subsequent generation of a local thrombus, and eventual transformation of the thrombosed vein into a fibrous cord. The endpoint of this process is functionally analogous to surgical removal of a vein. As a result, SVT is a normal and expected occurrence following sclerotherapy. However, in rare instances it can extend and lead to post-sclerotherapy thrombophlebitis, which usually occurs within 1 to 2 weeks after the treatment of larger vessels (usually >1 mm).[22]

硬化治疗后浅静脉血栓性静脉炎的发病，根据治疗技术和硬化剂种类而会有不同，已报告其发病率可高达6%。[23]

SVT及深静脉血栓同样被报道发生于静脉内激光烧蚀治疗静脉曲张后。[24]

静脉内插管

Largely exclusive to upper-limb SVT rather than lower-limb SVT. Nonetheless, SVT can occur as a result of cannulation of superficial veins of the lower limbs, and by irritant drugs delivered through the catheter.

恶性肿瘤

Though malignancy is highly associated with an increased risk of DVT and pulmonary embolism (PE), the association with SVT is not well known. Based on small retrospective cohort studies, among patients with SVT 10% to 15% may have a diagnosis of malignancy.

Trousseau 综合征（转移性浅静脉血栓性静脉炎）较罕见，其特征为反复发作的转移性 SVT，常发生于不常见的部位，例如上肢或胸部 [也被称为Mondor病（胸腹壁血栓性静脉炎）累及胸壁静脉时]。它常常与腺癌相关，特别是胰腺、肺、胃和前列腺癌。

SVT形成过程中，恶性肿瘤介导激活的凝血级联反应和恶性肿瘤产生的促凝血因子被认为是很重要的。

弱 查看所有

妊娠

关于妊娠和SVT的关系缺乏相关信息。在对 30,040 名妊娠女性的回顾性研究中，产后 48 小时内超声确诊存在 SVT 的患者比例大约为0.05%。[25] 年龄增大、经产数和高血压都是危险因素。[14][21][25]

妊娠相关的改变，例如促凝血因子的增多、纤溶活性的降低，可能解释了孕期，尤其产后阶段相关风险的增加。此外，显著地静脉扩张（和血液瘀滞），尤其在晚期妊娠，是 SVT 的危险因素。

口服避孕药物和激素替代疗法的应用

尚缺乏相关数据说明口服避孕药和激素替代疗法对于SVT的风险。根据一些对于应用口服避孕药与静脉血栓栓塞事件（常包含SVT）关系的研究，口服避孕药的患者发生静脉血栓的风险提高2~6倍，口服激素替代治疗的风险提高2~4倍。[26] Moreover, there is a suggestion that, among women who take an OCP, the risk of DVT is higher in those women with a history of SVT than those without.[27]

口服避孕药中含有的第三代孕酮，相对于第二代孕酮来说，其风险更高。

OCP and HRT are associated with exponentially higher risk of VTE when used by women with a thrombophilic condition.

口服避孕药和激素替代疗法所介导的促凝血因子和天然抗凝血蛋白的改变可以解释血栓的风险。特别是口服避孕药可引起活化蛋白 C 抵抗，正好与凝血因子V Leiden突变类似。

老年

发病率随着年龄的增加而升高（由20-30岁时0.05%~0.31%，到70-80岁时1.8%~2.2%）。[28]

history of prior VTE, including DVT and PE

The risk of SVT in patients with a history of VTE has not been well studied. However, in one study of patients with confirmed first spontaneous VTE (and without varicose veins, malignancy, or autoimmune disorders), SVT developed in 7.3% of patients over an average follow-up of 30 months.[18] In addition, it was noted that patients with a first spontaneous VTE and subsequent SVT were at 2-fold increased risk of recurrent VTE compared with patients with a first spontaneous VTE without subsequent SVT.

肥胖

超重被认为是静脉血栓栓塞的较轻的危险因素。[29][30][31] With regard to SVT, a 2.6-fold increased risk of SVT has been reported in overweight (BMI ≥28 kg/m²) patients when compared with patients with a BMI <28 kg/m², independent of the presence of varicose veins.[32]

肥胖似乎是SVT的危险因素，因为它易出现静脉淤血，同时引起凝血改变。[33]

长期制动（例如长途航空旅行）

长途航空旅行对于SVT的作用尚不清楚，它可能会引起很小一部分的SVT。

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