恶性肿瘤患者并发静脉血栓栓塞的临床研究  

Clinical studies in patients with cancer complicated by venous thromboembolism

作　　者：李颖[1] 赵晶[1] 姜达[1] 董倩[1] 崔彦芝[1] 张增叶[2] 

机构地区：[1]河北医科大学第四医院肿瘤内科,河北石家庄050011 [2]河北医科大学第三医院肿瘤内科,河北石家庄050051

出　　处：《肿瘤》2014年第8期745-749,共5页Tumor

基　　金：河北省卫生厅青年科技课题资助项目(编号:20110459)

摘　　要：目的:探讨恶性肿瘤患者血栓治疗的意义。方法:观察370例恶性肿瘤患者的静脉血栓发生率,检测所有患者的凝血功能和D-二聚体。血栓组18例患者给予低分子肝素钠5 000 U皮下注射(1次/12 h,共2次)以及常规抗肿瘤治疗。分析血栓形成的危险因素。比较血栓组和非血栓组患者的总生存和无进展生存的差异。结果:370例恶性肿瘤患者的血栓发生率为4.9%。血栓组的活化部分凝血活酶时间和凝血酶时间较非血栓组缩短(P<0.01),凝血酶原时间延长(P<0.01),纤维蛋白原升高(P<0.01),血栓组的D-二聚体高于非血栓组(P<0.05)。血栓组与非血栓组患者的总生存差异无统计学意义(P=0.690);非血栓组患者的中位无进展生存期较血栓组患者明显延长(P=0.002)。置入静脉导管(P=0.004)和升高白细胞治疗(P=0.035)是影响血栓形成的独立因素。结论:恶性肿瘤并发血栓患者可从抗凝治疗联合抗肿瘤治疗中获益。升高白细胞治疗和置入静脉导管是血栓形成的独立危险因素。Objective： To investigate the clinical significance of treatment of thrombosis in patients with malignant tumors. Methods： The incidence rate of venous thromboembolism （VTE） in 370 patients with malignant tumors was calculated. The coagulant function and D-dimer of all patients were examined. Eighteen patients with VTE received low molecular heparin sodium （subcutaneous injection of 5 000 U low molecular heparin sodium every 12 h for 2 times） and conventional anti-tumor therapy. The risk factors related to VTE were analyzed. The overall survival （OS） and progression-free survival （PFS） were compared between VTE group and non-VTE group. Results： In 370 patients with malignant tumors, the incidence rate of VTE was 4.9%. The activated partial thromboplastin time （APTT） and thrombin time （-I-1-） were shortened in VTE group as compared with those in non-VTE group （P 〈 0.01）. The prothrombin time （PT） was prolonged and the level of fibrinogen （FIB） was increased in VTE group （P 〈 0.01）. The level of D-dimer was higher in VTE group than that in non-VTE group （P 〈 0.05）. The OS between VTE group and non-VTE group was not significantly different （P = 0.690）. The median PFS of non-VTE group was significantly prolonged as compared with that of VTE group （P = 0.002）. Venous catheter placement （P = 0.004） and therapy of elevating white blood cell count （P = 0.035） were independent risk factors affecting VTE. Conclusion： Malignant tumor patients with VTE can benefit from anticoagulation and anti-tumor treatment. Venous catheter placement and therapy of elevating white blood cell count are the independent risk factors affecting VTE.

关 键 词：恶性肿瘤 静脉血栓栓塞 预后 治疗 

分 类 号：R733.4[医药卫生—肿瘤]