多发性骨髓瘤患者凝血因子活性与出血事件的相关性  

Correlation between coagulation factor activity and bleeding in patients with multiple myeloma

作　　者：于家琪 魏秀丽 YU Jiaqi;WEI Xiuli(The Fifth Clinical College of Xinxiang Medical University,Xinxiang 453000,Henan Province,China;Department of Hematology,Xinxiang First People's Hospital,Xinxiang 453000,Henan Province,China)

机构地区：[1]新乡医学院第五临床学院,河南新乡453000 [2]新乡市第一人民医院血液内科,河南新乡453000

出　　处：《新乡医学院学报》2024年第12期1129-1133,共5页Journal of Xinxiang Medical University

摘　　要：目的探讨初诊多发性骨髓瘤(MM)患者凝血因子活性与治疗前出血事件的相关性。方法选择2022年4月至2023年8月新乡市第一人民医院血液内科收治的42例初诊MM患者为观察组,以同期收治的20例营养不良性贫血患者为对照组,分析2组患者常规凝血指标和血浆凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅸ、Ⅹ、Ⅺ、Ⅻ活性的差异;根据MM患者接受治疗前是否发生出血事件分为出血组(n=10)和未出血组(n=32),比较2组患者的临床资料及血浆凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅸ、Ⅹ、Ⅺ、Ⅻ活性,分析MM患者凝血因子活性与出血事件的相关性,探讨影响MM发生出血事件的相关因素。结果观察组患者血浆凝血因子X活性显著低于对照组(P<0.05),2组患者活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)和D-二聚体(D-D)水平以及血浆凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅸ、Ⅺ、Ⅻ活性比较差异均无统计学意义(P>0.05)。Spearman相关性分析显示,观察组患者的血浆凝血因子X活性与APTT、PT水平呈负相关(P<0.05),与TT、FIB、D-D无相关性(P>0.05)。42例MM患者中,发生出血事件患者10例(23.8%),未发生出血事件患者32例(76.2%)。出血组与未出血组ISS分期MM患者的性别、年龄、免疫分型、Durie-Salmon分期、基础疾病比较差异均无统计学意义(P>0.05)。出血组MM患者中A亚型患者占比显著低于未出血组,B亚型患者占比显著高于未出血组(P<0.05)。出血组ISS分期Ⅰ期和Ⅱ期患者总占比显著低于未出血组,而Ⅲ期患者占比显著高于未出血组(P<0.05)。出血组MM患者血小板计数和血浆凝血因子X活性显著低于未出血组,APTT、PT、TT显著高于未出血组(P<0.05);2组患者的FIB、D-D及血浆凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅸ、Ⅺ、Ⅻ活性比较差异无统计学意义(P>0.05)。结论MM患者血浆凝血因子Ⅹ活性明显降低,且与治疗前出血事件的发生密切相Objective To explore the correlation between coagulation factor activity and pretreatment bleeding events in patients with a primary diagnosis of multiple myeloma(MM).Methods Totally 42 patients with a first diagnosis of MM admitted to the Department of Hematology of Xinxiang First People's Hospital from April 2022 to August 2023 were selected as the observation group,and 20 patients with dystrophic anemia treated during the same period were selected as the control group.The differences in routine coagulation indicators and the activity of plasma coagulation factors Ⅱ,Ⅴ,Ⅶ,Ⅷ,Ⅸ,Ⅹ,Ⅺ and Ⅻ in patients between the two groups were analyzed.According to whether the patients with MM had bleeding events before treatment,they were divided into bleeding group(n=10)and non-bleeding group(n=32).The clinical data and the activity of plasma coagulation factors Ⅱ,Ⅴ,Ⅶ,Ⅷ,Ⅸ,Ⅹ,Ⅺ and Ⅻ in patients between the two groups were compared.The correlation between coagulation factor activity and bleeding in MM patients was analyzed,and the relevant factors affecting bleeding in MM patients were discussed.Results The activity of plasma coagulation factor Ⅹ of patients in the observation group was significantly lower than that in the control group(P<0.05),and there was no statistically significant difference in activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen(FIB)and D-dimer(D-D)levels as well as the activity of plasma coagulation factors Ⅱ,Ⅴ,Ⅶ,Ⅷ,Ⅸ,Ⅺ and Ⅻ(P>0.05).Spearman correlation analysis showed that the activity of plasma coagulation factor Ⅹ of patients in the observation group was negatively correlated with APTT and PT levels(P<0.05),and not correlated with TT,FIB and D-D(P>0.05).Among the 42 MM patients,10 patients(23.8%)experienced bleeding events,and 32 patients(76.2%)did not experience bleeding events.There was no statistically significant difference in gender,age,immunophenotyping,Durie-Salmon staging,and underlying diseases in MM patie

关 键 词：多发性骨髓瘤 出血 凝血因子 凝血功能障碍 

分 类 号：R733.3[医药卫生—肿瘤]