原发免疫性血小板减少症发生血栓的影响因素研究

Factors Associated with Thrombosis in Primary Immune Thrombocytopenia

背景原发免疫性血小板减少症(ITP)是以血小板减少为特征的出血性疾病,但其血栓事件发生情况却高于正常人群,进而增加了其治疗难度,因此分析其血栓发生的危险因素非常必要。目的探究ITP患者发生血栓的相关影响因素。方法选取2010年1月至2021年6月于商丘市第一人民医院住院的725例ITP患者为研究对象,依据患者是否形成血栓分为血栓组及非血栓组。回顾性收集患者的一般资料、抗磷脂抗体检测结果及血栓类型。采用多因素Logistic回归分析探究ITP患者发生血栓的影响因素。结果725例ITP患者中非血栓组704例(97.1%)、血栓组21例(2.9%)。血栓组患者年龄≥50岁、有高血压史、有糖尿病史、激素使用>8周、脾切除、狼疮抗凝物(LA)阳性、抗心磷脂抗体(aCL)阳性所占比例高于非血栓组(P<0.05);血栓组与非血栓组患者疾病状态情况比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄〔≥50岁:OR=4.466,95%CI(1.008,19.797),P=0.049)〕、疾病状态〔慢性ITP:OR=3.046,95%CI(1.067,8.699),P=0.037〕、高血压史〔有:OR=9.031,95%CI(1.930,42.272),P=0.005〕、糖尿病史〔有:OR=5.919,95%CI(2.078,16.863),P=0.001〕、激素使用>8周〔是:OR=4.119,95%CI(1.465,11.580),P=0.007〕、LA〔阳性:OR=3.426,95%CI(1.145,10.254),P=0.028)〕、aCL〔阳性:OR=4.064,95%CI(1.357,12.169),P=0.021〕是ITP患者发生血栓的影响因素(P<0.05)。725例ITP患者中发生动脉血栓12例(1.7%)、静脉血栓8例(1.1%)、形成动静脉血栓1例(0.1%)。结论年龄≥50岁、疾病状态为慢性ITP、有高血压史、有糖尿病史、激素使用>8周、LA阳性、aCL阳性是ITP患者发生血栓的影响因素,临床治疗ITP时应特别注意预防其血栓的发生。

Background Patients with primary immune thrombocytopenia(ITP),a hemorrhagic disease characterized by thrombocytopenia,have increased incidence of thrombotic events,which increases the treatment difficulty.Therefore,it is necessary to determine the risk factors for thrombosis in ITP.Objective To identify the factors associated with thrombosis in ITP.Methods Seven hundred and twenty-five ITP inpatients(including individuals with and without thrombosis)were recruited from the First People's Hospital of Shangqiu.Demographics and results of testing for antiphospholipid antibodies and thrombosis type were collected retrospectively.Multivariate Logistic regression analysis was used to explore the influencing factors of thrombosis.Results Patients with thrombosis(n=704,97.1%)had higher rates of 50-year-olds and above,having hypertension history,diabetes history,and splenectomy,and higher prevalence of use of hormone over 8 weeks,lupus anticoagulant positivity,as well as anticardiolipin antibody positivity than those without(n=21,2.9%)(P<0.05).The difference of disease status between patients with and without thrombosis was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that older age(≥50 years)〔OR=4.466,95%CI(1.008,19.797),P=0.049)〕,chronic ITP〔OR=3.046,95%CI(1.067,8.699),P=0.037)〕,history of hypertension〔OR=9.031,95%CI(1.930,42.272),P=0.005〕,history of diabetes〔OR=5.919,95%CI(2.078,16.863),P=0.001〕,hormone use>8 weeks〔OR=4.119,95%CI(1.465,11.580),P=0.007〕,lupus anticoagulant positivity〔OR=3.426,95%CI(1.145,10.254),P=0.028〕,anticardiolipin antibody positivity〔OR=4.064,95%CI(1.357,12.169),P=0.021〕were independently associated with increased risk of thrombosis in ITP.Among the 725 participants,12(1.7%)had arterial thrombosis,8(1.1%)had venous thrombosis,and 1(0.1%)had arteriovenous thrombosis.Conclusion Fifty years old and above,chronic ITP,history of hypertension,history of diabetes,hormone use>8 weeks,lupus anticoagulant positivity,and anticardiolipin antibody positivity may be independent risk factors for thrombosis in ITP.Special attention should be paid to the prevention of thrombosis in clinical treatment of ITP patients.