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目的通过复习肿瘤性骨软化症(tumor induced osteomalacia,TIO)并发深静脉血栓形成(deep vein thrombosis,DVT)、肺栓塞(pulmonary embolism,PE)病例,以提高对该罕见病及其严重并发症的认识。方法分析2例TIO并发下肢DVT、PE患者的临床特点、诊治经过及结局,并进行文献复习及总结。结果患者1,男性,46岁;患者2,女性,52岁。病程均为2年余。临床表现为全身骨痛、乏力、活动困难,血液生物化学检查示低磷血症、碱性磷酸酶升高、磷廓清指数降低,影像学检查发现骨密度减低及致病肿瘤,2例患者确诊TIO;2例患者均有D-二聚体升高,临床评分提示PE可能,经深静脉彩超、CT肺动脉显影明确诊断并发DVT、PE。予抗凝治疗,植入下腔静脉滤器后行肿瘤切除术,患者TIO治愈,随访无再发血栓。结合文献检索到的1例维生素D缺乏性骨软化症并发DVT、致死性PE的老年患者分析,3例静脉血栓栓塞症共同危险因素为制动、骨折、年龄>40岁;肺栓塞症状轻重程度不一,隐匿者可无症状或仅有轻度胸闷、气短,严重者可发生急性呼吸循环骤停。结论 TIO并发DVT、PE为临床疑难重症,可能危及患者生命,临床评分联合D-二聚体筛查有重要参考价值,深静脉彩超、CT肺动脉显影可明确诊断,早期识别、及时治疗和多科协作是改善患者临床结局的关键。
OBJECTIVE: To improve the diagnosis of this rare disease and its serious complications by reviewing the cases of tumor induced osteomalacia (TIO) complicated with deep vein thrombosis (DVT) and pulmonary embolism (PE) understanding. Methods The clinical features, diagnosis, treatment and outcome of two cases of TIO complicated with lower extremity DVT and PE were analyzed and the literature review and summary were made. Results Patient 1, male, 46 years old; patient 2, female, 52 years old. Duration of more than 2 years. Clinical manifestations of the whole body bone pain, fatigue, difficulty in activities, blood biochemical tests showed hypophosphatemia, alkaline phosphatase increased, phosphorus clearance index decreased, imaging examination revealed lower bone mineral density and pathogenic tumors, 2 patients diagnosed TIO; D-dimer increased in both of the 2 patients. The clinical score suggested that PE may be diagnosed complicated by DVT and PE by deep venous ultrasonography and CT pulmonary angiography. To anticoagulant therapy, implanted in the inferior vena cava filter tumor resection, the patient cured TIO, no recurrence of thrombosis follow-up. Combined with the literature to retrieve a case of vitamin D deficiency osteomalacia with DVT, fatal PE in elderly patients, 3 cases of venous thromboembolism common risk factors for braking, fracture, age> 40 years; severity of pulmonary embolism symptoms Different, hidden persons can be asymptomatic or only mild chest tightness, shortness of breath, severe acute respiratory arrest can occur. Conclusions TIO is complicated with DVT and PE, which may endanger the patient’s life. The clinical score and D-dimer screening have important reference value. Deep venous ultrasonography and CT pulmonary angiography can confirm the diagnosis, early identification, timely treatment and multidisciplinary Collaboration is the key to improving the patient’s clinical outcome.