真性红细胞增多症和原发性血小板增多症患者发生再次血栓事件的危险因素分析

Risk factors for recurrent thrombosis in patients with polycythemia vera and essential thrombocythemia

目的分析并探讨真性红细胞增多症(PV)和原发性血小板增多症(ET)患者发生再次血栓事件(再栓)的临床特点及危险因素。方法回顾性分析首都医科大学附属北京安贞医院2001年2月至2016年11月诊治的38例发生再栓事件的ET和PV患者的临床资料,采用Logistic回归分析再栓事件危险因素。结果共计104例首次血栓事件的ET和PV患者中,38例(36.5%)患者发生再栓,年发生率为9.8%/人,ET组、PV组再栓年发生率分别为12.3%/人、5.7%/人。再栓事件共56次,42.1%发生在首次血栓形成后1年内;动脉血栓症占97.4%(以急性冠脉综合征最为多见),静脉血栓症占2.6%。ET组再栓以急性冠脉综合征最多见(18例,64.3%),PV组以脑梗死最常见(7例,70.0%)。2次及以上再栓患者中,PV(9例,90.0%)明显多于ET(7例,25.0%)。再栓组初诊WBC>12.5×10^9/L(52.6%对31.8%,P=0.036)、红细胞比容(Hct)>45%(50.0%对30.0%,P=0.046)、既往血栓史(86.8%对13.6%,P<0.001)、脾肿大(84.2%对33.3%,P<0.001)、治疗未缓解(52.6%对15.2%,P<0.001)、血栓事件分层高危患者占比(94.7%对53.0%,P<0.001)高于单次血栓组;Logistic回归分析显示,既往血栓史(OR=13.697,P=0.025)、脾肿大(OR=13.301,P=0.034)和血栓事件分层高危(OR=44.618,P=0.025)为ET/PV再栓的独立危险因素。结论ET和PV患者有较高的再栓发生率,ET患者再栓发生率高于PV患者,急性冠脉综合征多见;PV多次再栓发生率多于ET,脑梗死较多见。既往血栓史、脾肿大和血栓事件分层高危是再栓的独立危险预测因素。

Objective To analyze the clinical characteristics of recurrent thrombosis in patients with polycythemia vera (PV) and essential thrombocythemia (ET) to probe the risk factors for recurrent thrombosis in patients with ET and PV.Methods The clinical data of 104 ET and PV patients with thrombosis in Beijing Anzhen Hospital from February 2001 to November 2016 were retrospectively analyzed.Thrombosis reoccurred in 38 patients.Statistical analyses were performed by multivariate logistic regression for risk factors of recurrent thrombosis in ET and PV patients.Results Recurrent thrombosis occurred in 36.5% of patients with ET/PV,the total incidence rate in ET and PV patients was 9.8% patient-years,12.3% patient-years and 5.7% patient-years in ET and PV respectively.There were a total of 56 re-thrombotic events,and 42.1% of events occurred within 1 year after the first thrombosis.The arterial re-thrombosis was 97.4%(most of acute coronary syndrome,ACS),and venous events was 2.6%.The most common cases of re-thrombosis were ACS in ET patients (18 cases,64.3%),and cerebral infarction in PV patients (7 cases,70.0%).The number of PV patients with 2 times or more re-thrombotic events was significantly higher than that of ET patients (9 cases,90.0% vs 7 cases,25.0%).The proportion of the patients with WBC>12.5×10^9/L or Hct>45%,and thrombosis history or splenomegaly and high risk thrombotic events were higher than those with a single thrombus (52.6% vs 31.8%;50.0% vs 30.0%;86.8% vs 13.6%;84.2% vs 33.3%;52.6% vs 15.2%;94.7% vs 53.0%;P values were 0.036,0.046,<0.001,<0.001,<0.001 and <0.001,respectively).Logistic regression analysis showed that thrombosis history (OR=13.697,P=0.025),splenomegaly (OR=13.301,P=0.034) and high risk stratification of thrombotic events (OR=44.618,P=0.025) were independent risk factors for recurrent thrombotic events.Conclusions ET and PV patients had a higher risk of re-thrombosis.The incidence of re-thrombosis in ET was higher than in PV,ACS was more common cases of re-thrombotic events;but PV patients were more susceptible to multiple re-thromboses than ET ones,also with more cerebral infarction.Previous thrombus history,splenomegaly and high risk stratification of thrombotic events were independent risk predictors for re-thrombosis of ET and PV patients.