牙齦異常出血與類血友病：病例報告

Gingival Bleeding Disorders and von Willebrand Disease: Case Report

吳瓊玉(Chiung-Yu Wu) ； 林益弘(Yi-Hung Lin) ； 張佑琪(Yu-Chi Chang) ； 盧俊泰(Chun-Tai Lu) ； 蔡偉(Woei Tsay)

《臺灣牙周病醫學會雜誌》 14卷4期 (2009/12) Pp. 239-247

摘要

類血友病(von Willebrand disease, VWD)會造成牙齦異常出血或流血不止。患者爲一位30歲男子，曾於95年8月因牙齦腫脹及出血不止至本院牙周病科求診，經牙周病基本治療，全口牙齦呈現異常出血。患者自述牙齦容易出血不止已有多年之久，而其祖母、母親與姐姐亦有相同情形，且母親曾因經期大量出血而切除子宮。抽血檢查發現：Platelet Count=239*10^3/μL（參考值＝157~377*10^3/μL)，PT=11.8秒（參考值=9.4~11.5秒），aPTT=34.4秒（參考值=28.9~38.6秒），BT=8分（參考值=1~5分）。會診血液腫瘤科醫師與數次血液檢查發現：Factor Ⅷ:C=30%（參考值=48~179%），VWF:Ag=10%（參考值=46~158%），VWF:RCo=7.6%（參考值=41~173%），最後確定診斷爲類血友病(von Willebrand disease, severe type 1)。96年12月患者再度因牙齦腫脹出血至本科求診，由於患者特殊病史，遂分次、分象限逐步進行牙周病基本治療，並加壓與藥物止血，減少患者術後出血不止現象。von Willebrand disease發生率0.82~1%，比血友病發生率0.0025~0.01%高出許多，值得臨床醫師注意。

關鍵字

類血友病VWD ； 牙齦異常出血 ； 第八因子相關抗原VWF

並列摘要

Von Willebrand disease often causes gingival bleeding disorders. This 30-year-old man sought medical help because of gingival swelling and bleeding disorders at the Division of Periodontics, Changhua Christian Hospital in Aug. 2006. After the initial therapy of periodontitis, systemic bleeding disorders was suspected. Actually his gingival bleeding tendency could be traced back for twenty years. The family history disclosed that his grandmother, mother and sister had the similar bleeding problem. Moreover, his mother had received total hystectomy due to massive menorrhagia. The initial laboratory evaluation showed: Platelet count=239 *10^3/μL (reference value =157~377 *10^3/μL) APT=11.8s (reference value =9.4~11.5s) aPTT=34.4s(reference value =28.9~38.6s) Duke BT=8 mins (reference value =1~5mins). Further investigations by the hematology consultant revealed: Factor C=30% (reference value=48~179%)°AVWF: Ag=10% (reference value =46~158%) VWF: RCo=7.6% (reference value =41~173%). Thus, the conclusive diagnosis was von Willebrand disease, severe type 1. In Dec. 2007, the patient came back our division again because of gingival swelling and bleeding. We did the graded and sub-quadrant initial therapy for periodontitis smoothly by meticulous local hemostasis. It should draw attention to all clinicians that von Willbrand disease is the most popular congenital bleeding disorder.

並列關鍵字

von Willebrand disease VWD ； Gingival bleeding disorders ； von Willebrand factor VWF