恶性肿瘤合并静脉血栓患者临床特点及预后的研究

Clinical characteristics and prognosis in patients with malignant tumor complicated with venous thromboembolism

目的探讨恶性肿瘤合并静脉血栓栓塞症(VTE)患者的临床特点,并对其预后进行随访研究。方法选取2018年1月至2019年12月间陕西省人民医院收治的120例恶性肿瘤患者,收集患者年龄、性别、恶性肿瘤类型和临床表现等相关资料,总结恶性肿瘤合并VTE临床特点,对其治疗及预后进行随访观察。结果120例恶性肿瘤患者中,45例发生VTE。单纯恶性肿瘤组与恶性肿瘤合并VTE组患者在年龄、合并疾病、白细胞计数、血红蛋白、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)以及D-二聚体方面比较,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,恶性肿瘤合并VTE与糖尿病、长期卧床、VTE病史、肿瘤压迫和感染等因素有关(均P<0.05)。恶性肿瘤合并VTE肿瘤类型以肺癌为主(31.1%),其次为消化道肿瘤(22.2%);临床症状以呼吸困难为主(84.4%),其次为发热(55.6%)。VTE主要发生在恶性肿瘤确诊后3个月内(53.3%),患者经过低分子肝素治疗,有效28例,无效12例,死亡5例。结论恶性肿瘤合并VTE多发于恶性肿瘤确诊3个月内,症状以呼吸困难和发热为主,与糖尿病、长期卧床和肿瘤压迫等因素有关,预后较差,应给予高度关注。

Objective To observe the clinical characteristics in patients with malignant tumors complicated with venous thromboembolism(VTE),and to follow up the prognosis.Methods From January 2018 to December 2019,120 patients with malignant tumor admitted to Shaanxi Provincial People's Hospital were selected as the research subjects.The occurrence of VTE was observed,and the relevant data such as age,gender,type of malignant tumor and clinical manifestation were collected.The clinical characteristics of malignant tumor combined with VTE were summarized,and the treatment and prognosis were followed-up.Results Among 120 patients with malignant tumor,45(37.5%)had VTE.There were significant differences in age,disease,leukocyte count,hemoglobin,prothrombin time(PT),activated partial thromboplastin time(APTT)and D-dimer between malignant tumor group and VTE group(all P<0.05).Multivariate logistic regression analysis showed that malignant tumor complicated with VTE was associated with diabetes mellitus,long-term bed rest,history of VTE,tumor compression,infection and hormone ther-apy(all P<0.05).Lung cancer(31.1%)was the main type of malignant tumor complicated with VTE followed by digestive tract tumor(22.2%).Dyspnea(84.4%)was the main clinical symptom followed by fever(55.6%).VTE(53.3%)mainly occurred within 3 months after the diagnosis of malignant tumor.After treatment with low molecular weight heparin,efficacy was achieved in 28 patients,inefficacy was observed in 12 patients and 5 patients died.Conclusion VTE complicated with malignant tumors often occures within 3 months after the diagnosis of malignant tumors.The main symptoms include dyspnea and fever,which are related to diabetes mellitus,long-term bed rest and tumor compression.The prognosis is poor,so particular attention should be given to it.