骨髓增殖性肿瘤伴发血管性疾病的危险因素分析  

Risk factors of vascular complications in patients with myeloproliferative neoplasms

作　　者：陈烨[1] 韩雪[1] 白贝贝[1] 王芳[1] 史琳[1] 赵森[1] 王春键[1] 

机构地区：[1]首都医科大学附属北京安贞医院血液科,100029

出　　处：《中国医药》2015年第3期376-380,共5页China Medicine

摘　　要：目的探讨骨髓增殖性肿瘤（MPNs）患者血管性疾病的危险因素。方法收集首都医科大学附属北京安贞医院2004年2月至2014年6月诊治的93例MPNs[包括真性红细胞增多症（PV）、原发性血小板增多症（ET）和原发性骨髓纤维化（PMF）]患者的临床资料和实验室检查结果，其中24例患者无血管并发症，69例患者伴发血管疾病。对无、伴发血栓事件患者的临床资料（包括病史、年龄、性别、全血细胞计数、JAK2V617F基因突变等）进行回顾研究并采用Logistic回归分析危险因素。结果①93例MPNs患者中ET56例，Pv33例，PMF4例。JAK2V617F阳性率70．3％（45／64）；79．6％（74／93）患者伴有心血管危险因素，血管事件发生率74．2％（69／93），其中动脉血栓症63例，出血事件6例。②血栓事件危险因素分析：血栓组男性、白细胞计数〉10×10^9／L、血红蛋白〉170g／L、≥2项血管危险因素、栓塞史比率高于非血栓组[68．2％（45／66）比41．7％（10／24），65．2％（43／66）比37．5％（9／24），59．1％（39／66）比25．0％（6／24），59．1％（39／66）比25．0％（6／24），37．9％（25／66）比0．0％（0／24），P〈0．05]。Logistic回归分析显示，栓塞史[比值比（OR）=12．768，95％置信区间（CI）：2．320～70．265，P=0．003]、男性[OR=5．426，95％CI：1．592～18．488，P=0．007]、≥2项血管危险因素[OR=4．062，95％CI：1．194—13．818，P=0．025]、白细胞计数〉10×10^9／L[OR=3．741，95％CI：1．107～12．646，P=0．034]为MPNs血栓事件独立危险因素。结论MPNs血管并发症，尤其是血栓事件发生率高。栓塞史、男性、白细胞计数和血红蛋白高多项血管危险因素与MPNs发生血栓事件相关；白细胞计数增高、栓塞史、年龄〉60岁、多项血管危险因素为MPNs血栓事件的独立危险因素。Objective To investigate the risk factors of vascular disease in patients with myeloproliferative neoplasms （ MPNs ）. Methods The clinical data and laboratory examination results of 93 patients with MPNs, including polycythemia vera （PV） , essential thrombocytosis （ET） and primary myelofibrosis （PMF） , in Beijing Anzhen Hospital from February 2004 to June 2014 were collected. There were 69 patients suffering from vascular complications and 24 patients had no vascular complications. Clinical data including medical history, age, gender, whole blood counts and JAK2V617F mutation were retrospectively studied and the risk factors were analyzed using multivariate logistic regression analysis. Results （1） There were 56 of ET, 33 of PV, and 4 of PMF among the 93 patients. The positive rate of JAK2V617F mutation was 70.3% （45/64）. There were 79.6% （74/ 93 ） of the patients having cardiovascular risk factors. There were 69 vascular events occurred, showing an incidence of 74.2% （69/93） ; among them, 63 were arterial thrombosis and 6 were hemorrhagic complications. （2） The proportions of male, white blood cell count （WBC） 〉 10 ×10^9/L, hemoglobin （Hb） 〉 170 g/L, 〉/2 cardiovascular risk factors and thrombosis history were all higher in patients of thrombus than those in patients without thrombosis [68.2% （45/66） vs 41.7% （ 10/24）, 65.2% （43/66） vs 37.5% （9/24）, 59. 1% （39/66） vs 25.0% （6/24）, 59.1% （39/66） vs 25.0% （6/24）, 37.9% （25/66） vs 0.0% （0/24）, all P 〈 0.05 ]. Logistic regression analysis showed that thrombosis history [ odds ratio （OR） = 12. 768, 95% CI： 2. 320-70. 265, P = 0. 003 ], male gender[ OR =5. 426, 95% CI： 1. 592-18. 488, P =0. 007], ≥2 cardiovascular risk factors[ OR = 4. 062, 95% CI： 1.194 - 13.818, P = 0. 025 ] and WBC 〉 10×10^9/L [ OR = 3. 741, 95 % CI： 1. 107-12. 646, P = 0. 0341 were independent risk factors of thrombotic complication in patients with MPNs. Conclusions The thrombosis history,

关 键 词：骨髓增殖性肿瘤 真性红细胞增多症 原发性血小板增多症 血栓形成 

分 类 号：R733[医药卫生—肿瘤]