Clinical Features And Prognosis Of Venous Thromboembolism Patients With Hyperhomocysteinemia

Objective:To investigate the clinical characteristics of hyperhomocysteinemia combined with lower extremity deep venous thrombosis(DVT)and analyze the related factors of long-term prognosis.Methods:Patients with lower extremity deep venous thrombosis admitted to the Department of Vascular Surgery,Bethune Hospital,Shanxi Province from January 1,2018 to January1,2019 were included and divided into cases and controls according to the presence or absence of hyperhomocysteinemia.The general data of the patients were collected and followed up by outpatient clinic and telephone,and their clinical features and prognosis were collated and analyzed.Results:A total of 281 patients were enrolled in this study in case group and control group.In case group(n = 170),120 patients(70.59%)were male,50 patients(29.41%)were female,82 patients(73.87%)had mild HHcys,73 patients(65.77%)had moderate HHcys and 15 patients(13.51%)had severe HHcys.Distribution of thrombus types included peripheral thrombus in 43 patients(25.29%),central thrombus in 28 patients(16.47%),mixed thrombus in 99 patients(58.24%),9 patients(5.29%)died during follow-up,2 patients(1.17%)had hemorrhage,40 patients(23.53%)had recurrence,104patients(61.18%)developed PTS,including 64 patients(61.54%)with mild PTS,23patients(22.12%)with moderate PTS and 17 patients(16.35%)with severe PTS.In the control group(n = 111),44 patients(39.64%)were male,67(60.36%)were female,and37(33.33%)had pulmonary embolism.Among the distribution of thrombosis types,60(54.05%)had peripheral thrombosis,18(16.22%)had central thrombosis,33(29.73%)had mixed thrombosis,1(0.90%)died during follow-up,0(0.00%)had bleeding,12(10.81%)had recurrence,and 17(24.32%)developed PTS,including 14(51.85%)with mild PTS,11(40.74%)with moderate PTS,and 2(7.41%)with severe PTS.Statistical analysis of the clinical characteristics and prognosis of all patients:(1)There were statistical differences in gender(2 = 26.469,P < 0.001)and thrombosis classification(2 = 26.772,P < 0.001)between the case group and the control group,the proportion of males in the case group was higher than that in the control group,and the proportion of mixed thrombosis was higher than that in the control group;there were statistical differences in thrombosis recurrence(2 = 7.203,P = 0.007)and PTS incidence(2 = 41.977,P < 0.001)between the two groups in the prognosis comparison,and the thrombosis recurrence rate and PTS incidence in the case group were higher than those in the control group.(2)In the case group,there were statistical differences in HHcy grade between males and females(2 = 9.423,P = 0.009)and different genotypes(2 = 15.759,P =0.003),and the proportion of males was higher than that of females and the proportion of TT genotype was higher than that of CC/CT type in patients with moderate and severe HHcy;in the prognostic analysis,there were statistical differences in the incidence of PTS between different genotypes(2 = 13.782,P = 0.001),and the incidence of PTS in TT type was higher than that of CC/CT type.(3)In the case group,there was a statistically significant difference between HHcy grade and PTS severity(2 = 11.489,P < 0.022),and the incidence of moderate and severe PTS was higher in the severe HHcy population than in the mild and moderate HHcy population.4.In the comparison of prognosis in the case group,the incidence of PTS in patients with Hcy lowering less than 50% after 3 months under the same thrombus load was higher than that in patients with Hcy returning to normal or Hcy lowering ≥ 50%;5.In the analysis of follow-up results of all populations,there were significant differences in the distribution of obesity(2 = 50.3951,P < 0.001),thrombus type(2 = 87.5711,P < 0.001),thrombus recurrence(2 = 11.4661,P = 0.0007),genotyping(2 = 13.7815,P = 0.001)and Hcy lowering level(2 = 50.0290,P < 0.001)between the PTS group and the non-PTS group.Multivariate influencing factor analysis data were analyzed by binary logistic regression analysis,and the results showed that obesity,thrombosis recurrence,TT genotype,and Hcy reduction level less than 50%after 3 months of treatment were independent risk factors for the development of PTS.Conclusion:DVT patients with HHcy had higher thrombus involvement range,thrombus recurrence rate and incidence of PTS than DVT patients without HHcy;HHcy grade was associated with the severity of PTS,of which HHcy grade was positively correlated with the incidence of moderate and severe PTS;the incidence of PTS with TT genotype was higher than that with CC/CT genotype;under the same thrombus load,the incidence of PTS in patients with Hcy lowering less than 50% after 3 months was higher than that in patients with Hcy returning to normal or Hcy lowering ≥ 50%;obesity,thrombus recurrence,TT genotype and Hcy lowering level less than 50% after 3 months were independent risk factors for PTS in DVT patients.