影响肿瘤患者血小板输注效果的多因素分析

Logistic regression analysis of platelet transfusion effects in cases of cancer patients

目的探讨肿瘤患者血小板输注效果的影响因素。方法回顾性分析2010年1月1日至2011年6月30日在中国医学科学院肿瘤医院接受血小板输注的363例肿瘤患者资料，每例患者均采用随机数字表法抽取1次血小板输注入组分析，先进行单因素分析，然后对其中P≤0．2的因素进行多因素Logistic回归分析。结果363例患者中280例输注有效，总体有效率为77．1％。单因素分析显示年龄、血小板输注史、发热、抗生素4种因素对输注效果有影响（均P〈0．05），多因素Logistic回归分析显示血小板输注史（1～4次相比0次，OR=1．969，95％CI：1．135—3．417；≥5次相比0次，OR=5．260，95％CI：2．344～11．806）、抗生素（OR=2．020，95％CI：1．139～3．583）、发热（OR=1．789，95％CI：1．015—3．153）以及血小板库存天数（OR=1．559，95％CI：1．112～2．186）为血小板输注无效的独立危险因素。结论肿瘤患者血小板输注效果受多因素影响，减少输注次数、输注库存天数少的血小板、避免发热和使用抗生素期间输注可能改善输注效果。

Objective To explore the influencing factors of platelet transfusion effects in cancer patients. Methods A total of 363 cases of cancer patients undergoing platelet transfusion at our hospital from January 1 , 2010 to June 30, 2011 were enrolled. Only one transfusion was randomly selected for each patient for single-factor analysis. Then a binary Logistic regression analysis was performed with transfusion effects as a dependant variable and the variables with P〈0. 2 as covariates in single-factor analysis. Results Among them, there were 280 effective and 83 ineffective transfusions with an overall effective rate of 77.1%. The single-factor analysis revealed that the P values were 〈 0. 05 for age, platelet transfusion history, fever and antibiotic. Logistic analysis of multiple variables showed that platelet transfusion history（ 1 - 4 times compared to none, OR = 1. 969,95% CI： 1. 135 - 3.417; t〉 5 times compared to none, OR = 5. 260,95% CI： 2. 344 - 11. 806 ）, antibiotic （ OR = 2. 020,95% CI： 1. 139 - 3. 583 ）, fever （ OR = 1. 789, 95%CI：1.015 - 3. 153） and storage days of platelets （OR = 1.559,95% CI： 1.112 - 2. 186） were independent risk factors. Conclusions Influenced by multiple factors, the effects of platelet transfusion may be improved through reducing unreasonable transfusions, using fewer storage days of platelets and avoiding transfusions during fever and antibiotic uses.