血液肿瘤患者静脉血栓栓塞特点、预防与治疗的研究进展

Research progress of characteristics,prevention and treatment of venous thrombosis in hematological malignancies patients

肿瘤患者静脉血栓栓塞(VTE)发生率高, 是导致患者死亡的主要原因之一。然而, 现有研究主要集中于实体肿瘤, 血液肿瘤患者VTE相关研究相对少。白血病患者发生VTE的主要影响因素包括应用L-门冬酰胺(Asp)、高龄、中心静脉导管(PICC)及其他合并症。侵袭性淋巴瘤患者VTE发生风险高。多发性骨髓瘤(MM)患者在接受免疫调节剂治疗时, VTE发生风险可大幅增加。PICC或者免疫调节剂治疗可增加自体造血干细胞移植(auto-HSCT)患者VTE发生风险。异基因造血干细胞移植(allo-HSCT)患者易发生VTE, 而移植物抗宿主病(GVHD)可进一步增加患者VTE发生风险。目前缺乏可靠的研究数据指导血液肿瘤患者VTE的预防和治疗, 通常根据患者具体病情以确定VTE发生及出血风险。笔者拟就白血病、淋巴瘤、MM及造血干细胞移植(HSCT)患者VTE特点、预防与治疗的研究进展进行综述, 旨在为血液肿瘤患者中VTE的预防和治疗提供参考。

Incidence rate of venous thromboembolism(VTE)is high in tumor patients,and VTE is the main cause of death of those patients.However,the existing research mainly focuses on solid tumors,the research in hematologic neoplasms are relatively few.Influencing factors of VTE in leukemia patients mainly includes the use of L-asparagine(Asp),older age,the use of peripherally inserted central catheter(PICC)and other complications.Incidence risk of VTE in aggressive lymphoma is high.When patients with multiple myeloma(MM)are treated with immunomodulators,the risk of VTE will be greatly increased.PICC or immunomodulators will increase the risk of VTE in patients with autologous hematopoietic stem cell transplantation(auto-HSCT),while patients with allogeneic hematopoietic stem cell transplantation(allo-HSCT)are prone to thrombosis,and graft-versus-host disease(GVHD)will increase the risk of VTE.At present,few of reliable research for the guide of prevention and treatment of VTE in patients with hematological malignancies.The risk of VTE should be determined according to the specific status of patients.This paper reviews the research progress of characteristics,prevention and treatment of VTE in patients with leukemia,lymphoma,MM and hematopoietic stem cell transplantation(HSCT),so as to provide reference for the prevention and treatment of VTE in patients with hematologic neoplasms.