晚期肿瘤患者深静脉血栓发生因素分析

Risk factors for deep venous thrombosis in patients with advanced cancer

目的探讨晚期肿瘤患者发生深静脉血栓的相关危险因素。方法选取2013年3月至2014年3月间大连大学附属中山医院收治的50例晚期肿瘤发生深静脉血栓患者为观察组,选取同期入院治疗的50例晚期肿瘤未发生深静脉血栓患者为对照组。分析观察组患者形成深静脉血栓的危险因素,行Logistic回归多因素分析,随访24个月,统计两组患者的生存率。结果两组患者远处转移、中心静脉置管、糖尿病、感染、输血、血小板计数>350×109/L和D二聚体>500μg/dl相比,差异均有统计学意义(均P<0.05)。经Logistic回归多因素分析,远处转移(OR=7.382)、输血治疗(OR=1.458)及感染(OR=3.256)为晚期肿瘤患者发生深静脉血栓的高危因素。观察组患者平均生存时间为(10.8±2.4)个月,明显短于对照组患者的(16.7±3.1)个月,差异有统计学意义(P<0.05)。观察组患者12个月生存率为30.0%,明显低于对照组患者的68.0%,差异有统计学意义(P<0.05)。经治疗后,所有患者均于3 d内起效,治愈35例,有效6例,死亡9例,总有效率为82.0%。结论影响晚期肿瘤患者发生深静脉血栓的因素有远处转移、输血治疗及感染,深静脉血栓对晚期肿瘤患者预后有一定影响,临床需做好防治工作。

Objective To explore the risk factors for deep venous thrombosis（ DVT） in patients with advanced cancer. Methods Fifty patients with advanced cancer and DVT treated at Zhongshan Hospital Affiliated to Dalian University from March 2013 to March 2014 were selected as the observation group and 50 patients of the same period without DVT were selected as the control group. Risk factors for DVT were analyzed and multivariate logistic regression multi-factor analysis was conducted. The survival rate was calculated in the two groups,with a follow-up of 24 months. Results There was a significant difference in distant metastasis,central venous catheterization,diabetes,infection,blood transfusion,platelet count 350 × 109 / L and D dimer 500 μg / dl between the two groups（ P 0. 05）. Multi-factor logistic regression analysis showed that distant metastasis（ OR = 7. 382）,transfusion therapy（ OR = 1. 458） and infection（ OR = 3. 256） were the risk factors for DVT in patients with advanced cancer. The mean survival was（ 10. 8 ± 2. 4） months for the observation group which was significantly shorter than（ 16. 7 ± 3. 1） months of the control group（ P 0. 05）. The 12-month survival rate was 30. 0% for the observation group which was significantly lower than 68. 0% of the control group（ P 0. 05）. After treatment,all the patients responded to the treatment within 3 days. Thirty-five patients were cured,6 patients showed efficacy and 9 patients died. The overall efficacy rate was 82. 0%. Conclusion In patients with advanced cancer,risk factors for DVT are various,such as distant metastasis,transfusion therapy and infection. Clinical prevention and control should be strengthened for DVT has certain effect on the prognosis in patients with advanced cancer.