低分子肝素钙治疗恶性肿瘤合并血栓栓塞症60例疗效分析

The efficacy of low molecular weight heparin in sixty cancer patients with venous thromboembolism

目的:探讨低分子肝素钙(速碧林)治疗恶性肿瘤合并静脉血栓栓塞症(venous thromboembo-lism,VTE)的疗效及安全性。方法:回顾性分析2007年8月-2011年7月发生静脉血栓栓塞症的60例恶性肿瘤患者应用速碧林治疗后的转归情况。采用χ2检验分析疗效与各临床因素的相关性及二次血栓发生与各临床因素的相关性;Kaplan-Meier及COX回归分析临床因素与预后的关系。结果:经过皮下注射速碧林治疗,36例(60%)患者的血栓完全缓解(CR);21例(35%)部分缓解(PR);3例(5%)病情稳定(SD)。治疗过程中无严重并发症出现,速碧林的疗效与患者性别、年龄、肿瘤类型、分期、是否吸烟、是否静脉置管、风险评分、治疗时间的长短、血栓时症状的多少、化疗药物的种类、是否合并使用抗血管生成药物、血小板和D-二聚体计数等因素无明显相关性。血小板异常患者二次血栓的发生率明显高于血小板计数正常患者(33.3%vs 2.0%,P=0.009)。单因素分析提示分期早(I,II期)、治疗时间大于30 d和风险评分高(5分以上)的患者预后较好,但多因素分析表明只有分期和风险评分是独立的预后因素。结论:速碧林治疗恶性肿瘤合并血栓栓塞症安全有效,分期早和高风险的患者更能从抗凝治疗中受益。

Objective： To evaluate the efficacy and safety of low molecular weight heparin（LMWH,Fraxiparine） in cancer patients with venous thromboembolism（VTE）.Methods：The outcome of fraxiparine treatment in 60 cancer patients with VTE hospitalized from August 2007 to July 2011 were retrospectively analyzed.χ2 test was used to analyze the correlation between the efficacy,incidence of secondly thrombus and clinical factors,and Kaplan-Meier and COX regressive analysis were used to estimate the relationship between clinical factors and prognosis.Results：60%（36/60） of complete remission（CR）,35%（21/60） of partial remission（PR） and 5%（3/60） of stable disease（SD） were observed in fraxiparine treatment by hypodermic injection.No serious complication was found during the treatment.No obvious correlation was discovered between the efficacy of fraxiparine and clinic factors（sexuality,age,histology,stage of tumor,smoke,with central venous catheter or not,risk grades,period of fraxiparine treatment,chemotherapy agents,quantity of D-D or platelet） statistically.The incidence of secondly thrombus was higher in patients with abnormal platelet than in those with normal platelet（33.3% vs 2.0%,P=0.009）.In monovariate analysis,longer survival was seen in the patients who had early tumor stage（I or II）,who received long period of fraxiparine treatment（more than 30 days）,or who had high risk grades（〉5 points）.But only the tumor stage and risk grades were independent prognosis factors in multivariate analysis.Conclusion： Fraxiparine is safe and effective for treatment of VTE in cancer patients.Patients in early tumor stage at high risk may get more benefits from anticoagulant treatment.