利伐沙班治疗对N SCLC患者化疗后高凝状态的影响及发生静脉血栓的因素分析  

Effect of rivaroxaban on hypercoagulable state of patients with NSCLC after chemotherapy and the risk factors analysis of venous thrombosis

作　　者：赵萌 常娜 陈超[3] 张蕊 李博[1] ZHAO Meng;CHANG Na;CHEN Chao;ZHANG Rui;LI Bo(Department of Pharmacy,Tangshan People's Hospital,Tangshan 063000,China;Tangshan City Key Laboratory of Cancer Radiotherapy,Tangshan 063000,China;Department ofPathology,Zunhua People's Hospital,Zunhua 064200,China)

机构地区：[1]唐山市人民医院药剂科,河北唐山063000 [2]唐山市肿瘤放射治疗学重点实验室,河北唐山063000 [3]遵化市人民医院病理科,河北遵化064200

出　　处：《中国药物应用与监测》2022年第5期285-288,306,共5页Chinese Journal of Drug Application and Monitoring

基　　金：河北省2019年度医学科学研究课题计划项目(20191618)。

摘　　要：目的:研究利伐沙班治疗对非小细胞肺癌(NSCLC)患者化疗后高凝状态的影响及发生静脉血栓栓塞症(VTE)的因素。方法:采用回顾性研究的方法,选取我院2016年2月-2019年6月收治的165例NSCLC患者,根据利伐沙班治疗剂量将患者分为低(<10 mg·d^(-1))、中(10.0 mg·d^(-1))、高(>10mg·d^(-1))剂量组。比较三组患者凝血功能相关指标、VTE、出血事件发生率。采用Logistic模型分析发生VTE的危险因素。结果:经治疗后患者TT、PT、APTT、t-PA均明显增加,而FIB、PLT、D-二聚体、PAI-1均明显降低,随着给药剂量的增加,凝血功能相关指标的变化(增加或者降低)趋势明显增加(P<0.05).中剂量组、高剂量组的VTE发生率均明显低于低剂量组,而低剂量组、中剂量组的出血事件发生率明显低于高剂量组(P<0.05). Logistic回归分析显示肿瘤分期、癌胚抗原、血红蛋白以及D-二聚体是NSCLC患者并发VTE的危险因素(P<0.05)。结论:肿瘤分期、D-二聚体、癌胚抗原、血红蛋白是NSCLC患者化疗后合并VTE的独立危险因素,利伐沙班给药剂量10 mg·d^(-1)可有效改善患者高凝状态,降低VTE以及出血事件风险。Objective:To investigate the effect of rivaroxaban on hypercoagulable state of patients with non-small cell lung cancer(NSCLC)after chemotherapy and explore the risk factors of venous thromboembolism(VTE)in them.Methods:165 patients with NSCLC in our hospital from February 2016 to June 2019 were selected and divided into low-dose(<10 mg·d^(-1)),mediumdose(10.0 mg·d^(-1)),high-dose(>10 mg·d^(-1))group according to the dose of rivaroxaban.The coagulation function-related indexes,the incidence of VTE,bleeding events were compared among the three groups.The risk factors of VTE were analyzed by Logistic regression analysis.Results:The TT,PT,APTT and t-PA were significantly increased after treatment while the FIB,PLT,D-dimer and PAI-1 were significantly decreased.And all the indexes of coagulation function significangly increased or decreased with the increase of the dose of rivaroxaban(P<0.05).The incidence of VTE in the medium-dose group and high-dose group was significantly lower than that in the low-dose group while the incidence of bleeding events in the low-dose group and medium-dose group was significantly lower than that in the high-dose group(P<0.05).Logistic regression analysis showed that tumor stage,carcinoembryonic antigen(CEA),hemoglobin(Hb)and D-dimer were the risk factors of VTE in NSCLC patients(P<0.05).Conclusion:Tumor staging,D-dimer,CEA and Hb were the independent risk factors of VTE in NSCLC patients after chemotherapy.Rivaroxaban at 10 mg·d^(-1) could effectively improve the hypercoagulability of the patient and reduce the risk ofVTE and bleeding events.

关 键 词：利伐沙班 非小细胞肺癌 高凝状态 静脉血栓 

分 类 号：R969.4[医药卫生—药理学] R973.2[医药卫生—药学]