消化系统恶性肿瘤合并静脉血栓栓塞症的临床特点  

Clinical features of patients with digestive malignancy complicated with venous thromboembolism

作　　者：夏丽娜[1] 刘平 王丹[3] 王云逸 刘钟芬 陈晓艳 郑艳群[4] 姜丹凤 韩颖[1] 寇芙蓉[4] 王玺 张沛 刘巍[1,4] 王闫飞 XIA Lina;LIU Ping;WANG Dan;WANG Yunyi;LIU Zhongfen;CHEN Xiaoyan;ZHENG Yanqun;JIANG Danfeng;HAN Ying;KOU Furong;WANG Xi;ZHANG Pei;LIU Wei;WANG Yanfei(Department of Supportive Care,Peking University Cancer Hospital and Beijing Cancer Institute,Key Laboratory of Malignant Tumor Pathogenesis and Transformation Research,Ministry of Education,Beijing 100142,China;Department of Internal Medicine,Beijing Shangdi Hospital,Beijing 100193,China;Medical Department,Peking University Cancer Hospital and Beijing Cancer Institute,Key Laboratory of Malignant Tumor Pathogenesis and Transformation Research,Ministry of Education,Beijing 100142,China;Day Oncology Unit,Peking University Cancer Hospital and Beijing Cancer Institute,Key Laboratory of Malignant Tumor Pathogenesis and Transformation Research,Ministry of Education,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所支持治疗科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]北京市上地医院内科,北京100193 [3]北京大学肿瘤医院暨北京市肿瘤防治研究所医务处,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [4]北京大学肿瘤医院暨北京市肿瘤防治研究所日间化疗病区,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《肿瘤》2022年第9期626-637,共12页Tumor

基　　金：中华人民共和国人力资源和社会保障部百千万工程领军人才万人计划;北京市医院管理中心培育计划(PG2020023);北京市医院管理局“使命”计划专项经费(SML20181102);北京大学肿瘤医院科学研究基金(2021-23)

摘　　要：目的:分析消化系统恶性肿瘤患者合并静脉血栓栓塞症(venous thromboembolism,VTE)的临床特点。方法:回顾性分析2012年12月—2019年12月收治的143例消化系统恶性肿瘤合并VTE患者的临床资料。结果:143例患者中,141例(98.7%)的VTE发生于肿瘤确诊之后,中位时间为105.0 d(四分位距:23.0~373.0 d;范围:-86~3645 d);112例(78.3%)接受抗凝治疗,其中64例(57.1%)接受影像学复查以评价疗效,结果显示45例(70.3%)治疗显效或有效,19例(29.7%)治疗无效或恶化。143例患者中,98例(68.5%)在抗肿瘤治疗过程中发生VTE,其中66例(67.3%)继续接受标准抗肿瘤治疗,30例(30.6%)因VTE推迟或停止化疗,2例(2.1%)推迟靶向治疗。应用Khorana评分、Caprini评分和Padua评分评估VTE风险,结果显示中至高危患者分别占38.5%、96.5%和30.1%,提示现有评分工具对于消化系统恶性肿瘤患者合并VTE风险的预测能力有限。结论:VTE是消化系统恶性肿瘤患者的常见并发症,给抗肿瘤治疗计划的顺利完成带来不利影响。Objective:To evaluate the clinical characteristics of patients with malignancy of digestive system complicated with venous thromboembolism(VTE).Methods:Clinical data of 143 patients with malignancy of digestive system complicated with VTE admitted from December 2012 to December 2019 were collected and analyzed.Results:Of the 143 patients,141(98.7%)were diagnosed with VTE after cancer diagnosis,with a median time gap of 105.0 d(interquartile range:23.0-373.0 d;range:-86-3645 d).After the diagnosis of VTE,112(78.3%)patients received anticoagulant therapy,of them 64(57.1%)patients received imaging examination for evaluation of response to treatment.The treatment for VTE was markedly effective or effective in 45(70.3%)patients,while VTE remained unchanged or worsen in 19(29.7%)patients,despite of anticoagulant therapy.VTE occurred during antitumor therapy in 98(68.5%)patients,of whom 66(67.3%)continued to receive standard anti-tumor treatment,30(30.6%)had the chemotherapy delayed or termianted,while 2(2.1%)postponed targeted therapy.Using Khorana score,Caprini score and Padua score to retrospectively evaluate the VTE risk,patients with medium to high risk taken up 38.5%,96.5%and 30.1%,respectively,indicating poor sensitivity of Padua score and Khorana score.Conclusion:VTE is one of the common complications of digestive system malignancy and affects the implementation of antitumor therapy.

关 键 词：消化系统恶性肿瘤 静脉血栓栓塞症 抗凝治疗 

分 类 号：R735[医药卫生—肿瘤] R543.6[医药卫生—临床医学]