82例血液恶性肿瘤合并静脉血栓栓塞症患者的临床特点分析

Clinical characteristics of 82 cases with hematological malignancy accompanied by venous thromboembolism

目的:探讨血液系统肿瘤患者合并静脉血栓栓塞症(venous thromboembolism,VTE)的临床特点。方法:回顾性分析2012年1月至2020年12月宁夏医科大学总医院收治的82例血液肿瘤合并VTE患者的住院资料并作为病例组,以同期100例未合并VTE的血液肿瘤患者为对照组。结果:血液肿瘤并发VTE以急性白血病多见,其次为淋巴瘤和多发性骨髓瘤。单因素分析发现化疗、卧床>7 d、感染、中心静脉置管和既往手术史是血液肿瘤患者并发VTE的危险因素;多因素分析发现卧床>7 d和中心静脉置管是血液系统肿瘤合并VTE的独立危险因素。病例组患者中抗凝组(中位生存时间28个月,95%CI:15.5~40.5)较未抗凝组(中位生存时间7.5个月,95%CI:0~14.5)的中位生存时间较长,差异具有统计学意义(P=0.015)。结论:对于卧床以及中心静脉置管的血液系统肿瘤需警惕并发VTE,应对患者进行VTE危险因素评估,加强对血液系统肿瘤合并VTE患者的管理,个体化抗凝治疗可提高患者的生存率,改善VTE预后。

Objective:To investigate clinical features of patients with hematological malignancies accompanied by venous thromboembolism(VTE),so as to identify the risk factors of hematological malignancies with VTE at the early stage,and furthermore,to provide reference for early diagnosis and treatment of VTE.Methods:There were 82 hospitalized patients with hematological malignancies accompanied by VTE(case group)and 100 hospitalized patients with hematological malignancies without VTE(control group),and they all were diagnosed at General Hospital of Ningxia Medical University from January 2012 to December 2020.Patients'data were retrospectively analyzed and followed up.Results:Acute leukemia was more common in hematological malignancies with VTE,followed by lymphoma and multiple myeloma(MM).Univariate analysis found that chemotherapy,bed rest for more than 7 days,infection,central venous catheterization,and previous surgical history were the risks of hematological malignancies with VTE.Multivariate analysis found that bed rest for more than 7 days and central venous catheterization were independent risk factors for hematological malignancies with VTE.In the case group,the median survival time of the anticoagulation group(median survival time was 28 months,95%CI:15.5-40.5)was longer than that of the non-anticoagulation group(median survival time was 7.5 months,95%CI:0.0-14.5).The difference was statistically significant(P=0.015).Conclusions:It is necessary to be vigilant against VTE for patients with hematological malignancies because bed rest and central venous catheterization are independent risk factors for patients with hematological malignancies accompanied by VTE.Therefore,patients should be assessed for VTE risk factors and strengthen the management of patients with hematological malignancies accompanied by VTE.Individualized anticoagulation therapy can be used to improve the survival rate and prognosis of hematological malignancies patients with VTE.