Ph^(-)慢性骨髓增殖性肿瘤患者血栓事件危险因素的分析  

The Risk Factors of Thrombosis in Patients with Philadelphia Chromosome-negative Myeloproliferative Neoplasms

作　　者：赵一帆 林绍泽[1] 白雪 邢学仰[1] 陶红芳[1] 苏永忠[1] ZHAO Yi-Fan;LIN Shao-Ze;BAI Xue;XING Xue-Yang;TAO Hong-Fang;SU Yong-Zhong(Department of Hematology,The First Affiliated Hospital of Shantou University Medical College,Shantou 515041,Guangdong Province,China)

机构地区：[1]汕头大学医学院第一附属医院血液科,广东汕头515041

出　　处：《中国实验血液学杂志》2021年第6期1869-1874,共6页Journal of Experimental Hematology

基　　金：汕头市科技计划项目(汕府科[2020]5号)。

摘　　要：目的:了解慢性骨髓增殖性肿瘤(MPN)患者血栓事件并发症概况,探讨患者初诊时和随访中血栓事件发生的相关危险因素。方法:收集388例于本院就诊的MPN患者的临床资料,通过门诊及电话随访追踪预后,运用统计学方法分析血栓事件的危险因素。结果:388例MPN患者中,161例(41.49%)患者在初诊时或随访中出现血栓事件,类型以动脉血栓(92.55%)为主,其中初诊时并发血栓事件患者达到146例(96.27%),314例完成随访的患者中出现新发血栓或原有血栓进展的有36例(14.88%)。多因素分析提示,年龄(P<0.001,HR:1.033,95%CI:1.016-1.051)、JAK2V617F突变(P=0.037,HR:1.72,95%CI:1.033-2.862)、高血压病(P<0.001,HR:2.639,95%CI:1.659-4.197)、高脂血症(P<0.001,HR:2.659,95%CI:1.626-4.347)是MPN患者初诊时发生血栓事件的独立危险因素。而在随访过程中,年龄(P=0.016,HR:1.032,95%CI:1.006-1.059)和既往血栓病史(P=0.019,HR:2.194,95%CI:1.135-4.242)为新发不同部位血栓或原血栓基础上发生进展的独立危险因素。结论:高龄、JAK2V617F突变或伴有高血压病、高脂血症的患者在初诊时发生血栓事件的风险更高,而高龄或存在既往血栓病史的患者则在随访过程中表现出更高的血栓事件进展风险。Objective: To investigate the overview of thrombosis in myeloproliferative neoplasms( MPN) patients,and to explore the risk factors of thrombosis at diagnosis and during follow-up. Methods: The clinical data of 388 MPN patients treated in our hospital were collected. The patients were followed up by outpatient and phone. The risk factors of thrombosis were analyzed by statistical methods. Results: Among 388 MPN patients,161 patients( 41.49%) showed thromboses at diagnosis or during follow-up. Among them,92.55% were arterial thromboses,146 cases( 96.27%) were complicated with thromboses at diagnosis,and 36 cases( 11.46%) showed newly thromboses or progression of previous thromboses among the 314 received full follow-up patients. Age( P < 0. 001,HR: 1. 033,95% CI: 1. 016-1. 051),JAK2 V617 F mutation( P= 0.037,HR: 1.72,95%CI: 1.033-2.862),hypertension( P<0.001,HR: 2. 639,95%CI: 1.659-4. 197) and hyperlipidemia( P < 0. 001,HR: 2. 659,95%CI: 1. 626-4. 347) were the independent risk factors affecting thrombosis at diagnosis of the patients. During the follow-up,age( P = 0.016,HR: 1. 032,95%CI: 1.006-1.059) and previous thrombosis history( P= 0.019,HR: 2.194,95%CI: 1.135-4.242) were the independent risk factors affecting the progression of thrombosis at different sites or on the basis of the previous thrombosis in the patients.Conclusion: Patients with advanced age,JAK2 V617 F mutation or complicated with hypertension and hyperlipidemia shows a higher risk of thrombosis at diagnosis,while the patients with advanced age or previous thrombosis history shows a higher risk of progression of thrombosis during the follow-p.

关 键 词：慢性骨髓增殖性肿瘤 血栓 JAK2V617F突变 年龄 

分 类 号：R733.3[医药卫生—肿瘤] R551.3[医药卫生—临床医学]