急性期一時的下大静脈フィルターを用い軽快した原発性抗リン脂質抗体陽性肺塞栓症の1例

A Case of Anti-phospholipid Antibody Syndrome with Pulmonary Embolism Treated by a Temporary Inferior Vena Cava Filter and Anticoagulant Therapy

　患者は29歳，男性．突然の労作時呼吸困難出現，精査加療目的にて当院紹介入院．胸部CTにて肺動脈内に血栓を，肺血流シンチにて欠損像を認め，肺塞栓症と診断した．下大静脈内に遊離血栓を認め，急性期一時的下大静脈フィルター留置術を施行した．抗凝固療法および血栓溶解療法にて，下大静脈内遊離血栓は消失し，永久型下大静脈フィルターは留置しなかった．Intrnational normalized Ratio（INR）2.5を目標にワーファリンによる抗凝固療法を継続し，発症後約2年間血栓症再発を認めていない．本症例は膠原病合併がなく，抗カルジオリピン複合体抗体陽性，かつ血栓症を認め，原発性抗リン脂質抗体症候群と診断した．本症候群に伴う肺塞栓症例において永久型下大静脈フィルターの適応は未だ一定しておらず，急性期一時的下大静脈フィルター留置と慢性期の十分な抗凝固療法の有用性を示す症例と考え，報告した．

A 29-year-old man was admitted with pulmonaryembolism. An abdominal CT showed thrombosis in the inferior vena cava. A temporary inferior vena cava filter was inserted immediately. He was treated with heparin, urokinase, tissue plasminogen activator and warfarin. The venography on the 30th day showed no thrombus. The temporary inferior vena cava filter was removed. A permanent inferior vena cava filter for prevention of pulmonary embolism was not inserted. The patient was diagnosed as having anti-phospholipid antibody syn-drome by the existence of anticardiolipin antibody in his blood, on 2 occasions at 10 weeks. The patient made satisfactory progress after discharge with warfarin ther-apy over a period of two years, targeted at an interna-tional normalized ratio (INR) of 2.3. The temporary infe-rior vena cava filter and anticoagulant therapy were useful treatments for anti-phospholipid antibody syn-drome with pulmonary embolism.