慢性骨髓增殖性肿瘤患者血栓形成相关因素及外周血RPR、DFR对血栓形成的预测效能  

Related factors of thrombosis in patients with chronic myeloproliferative neoplasms and the predictive efficacy of peripheral blood RPR and DFR for thrombosis

作　　者：郭莉[1] 魏秀丽[1] 王继芳[1] 吴志敏[1] GUO Li;WEI Xiu-li;WANG Ji-fang;WU Zhi-min(Department of Hematology,Xinxiang First People's Hospital,Xinxiang 453000,Henan,CHINA)

机构地区：[1]新乡市第一人民医院血液内科,河南新乡453000

出　　处：《海南医学》2023年第21期3087-3091,共5页Hainan Medical Journal

基　　金：河南省医学科技攻关计划项目(编号:LHGJ20191301)。

摘　　要：目的探讨慢性骨髓增殖性肿瘤(MPN)患者血栓形成相关因素及外周血红细胞分布宽度与血小板比值(RPR)、D-二聚体/纤维蛋白原比值(DFR)对血栓形成的预测效能。方法回顾性分析2019年1月至2022年12月期间新乡市第一人民医院血液内科收治的122例MPN患者的临床资料,根据患者是否有血栓形成分为血栓形成组(n=37)和非血栓形成组(n=85)。比较两组患者的临床资料和D-二聚体(DD)、纤维蛋白原(FIB)、DFR、外周血血小板计数(PLT)、红细胞分布宽度(RDW)和RPR。采用多因素Logistic回归法分析MPN患者血栓形成的影响因素。应用受试者工作特性曲线(ROC)评估外周血RPR、DFR对MPN患者血栓形成的预测价值。结果血栓形成组患者在年龄≥60岁、原发病真性红细胞增多症(PV)、吸烟、高血压、脑卒中、既往血栓史比例和血红蛋白(Hb)、外周血白细胞(WBC)计数、RDW、DD、FIB水平方面高于非血栓形成组,而PLT计数明显低于非血栓形成组,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,高龄、既往血栓史、RDW≥18.01%、DD≥4.38 mg/L是MPN患者血栓形成的影响因素(P<0.05);血栓形成组患者外周血RPR、DFR分别为0.05±0.01、(1.23±0.39)×10^(-3),明显高于非血栓形成组的0.03±0.01、(1.08±0.25)×10^(-3),差异均有统计学意义(P<0.05);ROC分析结果显示,外周血RPR、DFR预测MPN患者血栓形成的AUC(95%CI)分别为0.812(0.798~0.826)、0.754(0.705~0.803),截断值分别为0.036、1.125×10^(-3),特异度分别为65.88%、57.65%,敏感度分别为91.89%、91.89%,两者联合预测的AUC为0.904(0.867~0.941),特异度为87.06%,敏感度为83.78%。结论MPN患者血栓形成与年龄、既往血栓史、RDW、DD有关。外周血RPR、DFR水平在MPN血栓形成患者中明显升高,对MPN患者血栓形成具有较高的预测价值。Objective To explore the correlation factors of thrombosis in patients with chronic myeloproliferative tumor(MPN)and the predictive efficacy of red cell distribution width to platelet ratio(RPR)and Ddimer/fibrinogen ratio(DFR)in thrombosis.Methods The clinical data of 122 MPN patients admitted to the Department of Hematology,Xinxiang First People's Hospital from January 2019 to December 2022 were retrospectively analyzed.According to whether the patients had thrombosis,they were divided into thrombosis group(n=37)and nonthrombosis group(n=85).The clinical data,Ddimer(DD),fibrinogen(FIB),DFR,peripheral blood platelet count(PLT),red blood cell distribution width(RDW),and RPR of the two groups were compared.Multivariate Logistic regression was used to analyze the influencing factors of thrombosis in MPN patients.Receiver operating characteristic curve(ROC)was used to evaluate the value of peripheral blood RPR and DFR in predicting thrombosis in MPN patients.Results The proportions of patients with age≥60 years old,primary polycythemia vera(PV),smoking,hypertension,stroke,previous history of thrombosis,and hemoglobin(Hb),peripheral blood white blood cell(WBC)count,RDW,DD,FIB levels in the thrombosis group were significantly higher than those in the nonthrombosis group,while PLT count was significantly lower than that in the nonthrombosis group,with statistically significant differences(P<0.05).Multivariate Logistic regression analysis showed that advanced age,previous history of thrombosis,RDW≥18.01%,and DD≥4.38 mg/L were the influencing factors of thrombosis in MPN patients(P<0.05).The peripheral blood RPR and DFR in the thrombosis group were 0.05±0.01 and(1.23±0.39)×10^(-3),respectively,which were significantly higher than 0.03±0.01 and(1.08±0.25)×10^(-3) in the nonthrombosis group(P<0.05).ROC analysis showed that the AUC(95%CI)of peripheral blood RPR and DFR for predicting thrombosis in MPN patients were 0.812(0.798-0.826)and 0.754(0.705-0.803),respectively,and the cutoff values were 0.036 and 1.125×1

关 键 词：慢性骨髓增殖性肿瘤 血栓 红细胞分布宽度与血小板计数比值 D-二聚体/纤维蛋白原比值 影响因素 预测效能 

分 类 号：R739.42[医药卫生—肿瘤]