老年恶性肿瘤合并静脉血栓栓塞症患者的临床特点及预后分析

Clinical characteristics and prognosis of elderly patients with malignant tumors complicated with venous thromboembolism

目的分析老年恶性肿瘤合并静脉血栓栓塞症(VTE)患者的临床特点及预后。方法对2003年1月至2013年1月北京医院280例恶性肿瘤合并VTE患者的临床资料进行回顾性分析,分析比较老年组和非老年组的临床特点和预后。结果280例肿瘤合并VTE中老年患者167例(59.6%)、非老年患者113例(40.4%),年龄分别为(75.2±6.1)岁和(53.9±8.2)岁。老年组合并高血压、冠心病、心功能不全和慢性阻塞性肺疾病(COPD)的比例高于非老年组,合并肝脏疾病比例低于非老年组;老年组泌尿系统肿瘤、制动>3 d、创伤史及手术史(>3个月)比例高于非老年组,而化疗史及手术史(<1个月)的比例低于非老年组(均P<0.05)。临床表现中发热及下肢浮肿老年组比例高于非老年组(χ2=6.043、3.862,P=0.014、0.049),老年组肺栓塞严重程度指数(PESI)评分显著高于非老年组(t=3.339,P=0.001)。实验室检查中,老年组血小板水平低于非老年组,而D-二聚体水平老年组显著高于非老年组(Z=-2.383、-3.150,P=0.017、0.002)。截至随访时间老年组共死亡89例,平均生存时间为(29.3±2.8)个月;而非老年组共死亡41例,非老年组患者平均生存时间为(49.7±4.1)个月,老年组死亡人数比例(89/167,53.3%)高于非老年组(41/113,36.3%)(χ2=8.394,P=0.004),Log-rank检验结果显示两组生存时间差异有统计学意义(χ2=8.878,P=0.003)。二分类Logistic回归分析结果显示,老年男性(≥65岁)(OR=3.263,95%CI:1.600~6.654)和泌尿系统肿瘤(OR=4.875,95%CI:1.526~15.571)是老年恶性肿瘤患者合并VTE死亡的预测因素。结论恶性肿瘤患者合并VTE在老年患者中更为常见,老年患者中并发症较多,病情严重程度和病死率高,男性及泌尿系统肿瘤是老年患者死亡的预测因素。

Objective To analyze the clinical features and prognosis of elderly patients with malignant tumors complicated with venous thromboembolism(VTE).Methods The clinical data of 280 patients with malignant tumors and VTE hospitalized in Beijing Hospital from January 2003 to January 2013 were retrospectively analyzed.The clinical features and prognosis were analyzed and compared between the elderly and non-elderly groups.Results Of the 280 patients with VTE,167(59.6%)were elderly and 113(40.4%)were non-elderly,with an average age of(75.2±6.1)years and(53.9±8.2)years,respectively.Patients in the elderly group were associated with higher incidences of hypertension,coronary heart disease,cardiac insufficiency and chronic obstructive pulmonary disease,lower rate of liver disease,higher proportions of urinary system tumors,braking for more than 3 d,trauma history and surgery history(>3 months),lower proportions of chemotherapy history and surgery history(<1 month),increased occurrences of fever and lower extremity edema(χ2=6.043,P=0.014;χ2=3.862,P=0.049),a higher score of pulmonary embolism severity index(t=3.339,P=0.001),a lower platelet level in the elderly group(Z=-2.383,P=0.017),and a higher D-dimer level(Z=-3.150,P=0.002)compared with those in the non-elderly group(all P<0.05).Up to the follow-up time,89 elderly patients in the elderly group died,with an average survival time of(29.3±2.8)months.However,41 patients died in the non-elderly group with an average survival time of(49.7±4.1)months.The proportion of death in the elderly group(89/167,53.3%)was higher than that in the non-elderly group(41/113,36.3%)(χ2=8.394,P=0.004).Log-rank test showed that the difference in survival time between the two groups was statistically significant(χ2=8.878,P=0.003).The binary Logistic regression analysis showed that elderly men(≥65 years)(OR=3.263,95%CI:1.600~6.654)and urinary system tumors(OR=4.875,95%CI:1.526~15.571)were predictive factors of death in the elderly with malignant tumor and VTE.Conclusions Patients with malignant tumors and VTE are more common in elderly patients.Elder patients have more comorbidities,greater disease severity and a higher rate of mortality.And male and urinary system tumors are predictors of death in elderly patients.