骨转移癌患者下肢深静脉血栓形成的危险因素分析

Analysis of risk factors for deep vein thrombosis of the lower extremity in patients with bone metastase

目的分析骨转移癌患者下肢深静脉血栓（DVT）的发生率和危险因素。方法回顾性分析90例骨转移癌患者的临床资料，采用彩色多普勒超声检查明确双下肢DVT的发生情况，并对患者的性别、年龄、体重、肿瘤部位、卧床时间等可能影响下肢DVT发生的危险因素进行单因素和多因素分析。结果90例骨转移癌患者中，有24例发生下肢DVT，DVT的发生率为26．7％（24／90），其中男性16例，女性8例；左下肢6例，右下肢14例，双下肢4例；无症状者15例，有症状者9例。单因素分析显示，患者的血型、卧床时间、是否伴病理性骨折、病灶数目、原发灶是否已知、红细胞压积、纤维蛋白原水平与下肢DVT的发生有关。Logistic多因素回归分析显示，下肢DVT发生的独立危险因素为卧床时间长、伴病理性骨折和纤维蛋白原水平高（均P〈0．05）。结论骨转移癌患者下肢DVT的发生率较高。卧床时间长、伴病理性骨折、纤维蛋白原水平增高是骨转移癌患者下肢发生DVT的独立危险因素。对卧床时间〉3d、伴病理性骨折、纤维蛋白原〉4g／L的患者，应常规行下肢深静脉彩色多普勒超声筛查。一旦发现DVT，应尽早治疗。

Objective To analyze the risk factors for deep vein thrombosis （DVT） of the lower extremity in patients with bone metastases. Methods Ninety patients with bone metastases were admitted to our hospital From January 2010 to December 2011, and their clinical data were retrospectively analyzed. There were 57 males and 33 females with a mean age of 61 years （range, 27 to 78 years）. On admission, all cases were detected by color Doppler ultrasonography for DVT of bilateral lower extremities. Univariate and multivariate analyses were performed to determine the probable risk factors including gender, age, body weight, tumor location, bed confinement and etc. Results Among the 90 patients, DVT was found in 24 patients on admission and the DVT incidence was 26.7% （24/90）. The univariate analysis showed that bed confinement, multiple metastasis, pathological fracture, primary lesion detected, blood group, fihrinogen and hematocrit were significantly related to the incidence of DVT （ P 〈 0.05 ）. The logistic multivariate regression analysis showed that bed confinement, pathological fracture and fibrinogen were independent risk factors for the incidence of DVT. Conclusions Bed confinement, pathological fracture and fibrinogen are independent risk factors for the incidence of DVT for patients with bone metastases. Patients with bed confinement 〉 3 days, pathological fracture or fibrinogen 〉 4 g/L should be routinely screened for lower extremity DVT on admission. Once identified, the DVT patients should be treated as early as possible.