恶性肿瘤合并静脉血栓形成35例临床研究  

Clinical study of venous thromboembolic events complicated with malignant tumor: An analysis of 35 cases

作　　者：林莉[1] 徐建明[1] 王岩[1] 刘建芝[1] 李志强[1] 刘烈军[1] 赵传华[1] 葛飞娇[1] 李珊珊[1] 

机构地区：[1]解放军307医院肿瘤治疗中心消化肿瘤科,北京100071

出　　处：《临床肿瘤学杂志》2010年第2期153-156,共4页Chinese Clinical Oncology

摘　　要：目的探讨恶性肿瘤患者合并静脉血栓形成(VTE)的影响因素、治疗及血栓形成对生存的影响。方法回顾性分析本科近年收治的35例合并VTE的恶性肿瘤患者的临床资料;对栓塞部位、血栓是否再发、血小板、D-二聚体及纤维蛋白水平及患者生存资料进行分析。结果6例肺栓塞(PTE)患者中3例于3小时内死亡,3例治疗后好转;29例深静脉血栓(DVT)患者中痊愈11例(37.9%),好转5例(17.2%),无效13例(44.8%),其中2例死于溶栓后肺栓塞。上肢发生DVT的患者中位生存期为210天,高于其它部位发生DVT的患者(P=0.018)。恶性肿瘤患者发生VTE时血浆D-二聚体及纤维蛋白原水平明显高于正常值,且D-二聚体高水平患者的中位生存期(70天)远低于低水平的患者(450天)。结论恶性肿瘤患者并发VTE后严重影响患者的生存,延误了抗肿瘤治疗的时机,治疗主要采用抗凝、祛聚集等,溶栓的好处有待进一步研究确认。D-二聚体以及纤维蛋白水平对诊断VTE及判断预后具有重要的辅助作用,治疗中血栓复发的患者预后差。Objective To study the influencing factors, treatment and prognosis of malignant tumor patients with venous thromboembolic events （VTE）. Methods The site of thrombosis, whether the recurrence of thrombosis, platelet, D-dimer and fibrin- ogen level of thirty five VTE patients with malignant tumor were analyzed. Results Among 6 cases complicated with pulmonary embolism（PTE） ,3 cases died within 3 hours, the other recovered after treatment, 11 cases （37.9%）obtained complete response among 29 cases with deep venous thrombosis（DVT） , 5 cases partial response （ 17.2% ） , and 13 cases （44. 8% ） progress proceed. Two cases died of PTE after thrombolisis. The median survival time of proximal-vein thrombosis was 210 days which was longer than those oc- curred on other section, it showed significant difference （P = 0. 018）. D-dimer and fibrinogen increased when VTE occurred, the median survival time of patients with high level D-dimer was 70 days which was lower than those with low levels （ 450 days ）, it also showed significant difference （ P = 0. 038 ）. Conclusion The main treatments of anti-VTE are anticoagnlation and antiassemblent. The benefit of thrombolisis is debated. D-dimer, Fibrinogen in the diagnosis and determine the prognosis of patients with VTE is an important supporting role. The patients with recurrence of thrombosis had poor prognosis.

关 键 词：恶性肿瘤 静脉血栓形成 深静脉血栓 肺栓塞 

分 类 号：R730.6[医药卫生—肿瘤]