真性红细胞增多症患者并发血栓形成的高危因素分析

High risk factors of thrombosis in patients with polycythemia vera

目的探讨真性红细胞增多症患者并发血栓形成的高危因素。方法抽取2019年1月至2021年12月于郑州大学第一附属医院就诊的真性红细胞增多症患者91例,收集患者的性别、年龄、血常规等指标,行尿酸、脾脏及血栓事件相关检查,采集患者的高血压、糖尿病、高血脂、血栓病史及吸烟史,并根据初次入院诊疗时是否存在血栓,将患者分为血栓组与无血栓组。各指标组间差异采用单因素分析法进行比较,最终将可能有意义的指标作为自变量带入行多因素Logistic回归分析。结果单因素分析结果显示,真性红细胞增多症患者血栓形成的高危因素为年龄≥60岁、JAK2-V617F基因突变负荷≥75%、红细胞比容(HCT)≥45%及高血脂(P<0.05),其中JAK2-V617F基因突变负荷≥75%的患者血栓形成的风险高于JAK2-V617F基因突变负荷<75%的患者(P=0.001);脾大、白细胞计数≥15×109/L,血小板计数≥300×109/L、淋巴细胞百分比<19.3%、红细胞分布宽度≥14.5%、高血压病史、吸烟史、糖尿病均非真性红细胞增多症患者血栓形成的高危因素(P均>0.05)。多因素Logistic回归分析显示,年龄≥60岁、JAK2-V617F基因突变负荷≥75%、HCT≥45%,高血脂是真性红细胞增多症患者血栓形成的独立危险因素(P<0.05)。结论在真性红细胞增多症患者中,年龄≥60岁、JAK2-V617F基因突变负荷≥75%、HCT≥45%、高血脂是其血栓形成的高危因素,对此类患者应重点预防血栓形成,从而改善患者预后。

Objective To investigate the high risk factors of thrombosis in patients with polycythemia vera.Methods A total of 91 patients with polycythemia vera treated in the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2021 were selected.The indicators including gender,age,blood routine were collected from these patients,and they all underwent the uric acid,spleen and thrombotic events examinations.The history of hypertension,diabetes mellitus,hyperlipidemia,thrombosis and smoking were collected from these patients.All the patients were divided into thrombus group and non-thrombus group according to occurrence of thrombus at the time of initial admission.The difference of each index between the two groups was analyzed by the single factor analysis method,finally,the possible meaningful indexes were taken as independent variables into the multivariate Logistic regression analysis.Results The results of univariate analysis showed that the high risk factors of thrombosis in patients with polycythemia included age≥60 years、mutation load of JAK2-V617F gene≥75%,hematocrit(HCT)≥45%,and hyperlipidemia(P<0.05).The risk of thrombosis in polycythemia vera patients with mutation load of JAK2-V617F gene≥75%was higher than that in polycythemia vera patients with mutation load of JAK2-V617F gene<75%(P=0.001).The high risk factors of thrombosis in polycythemia vera patients included hypersplenotrophy,white blood cell count≥15×109/L,blood platelet≥300×109/L,lymphocyte<19.3%,red blood cell distribution width≥14.5%,history of hypertension,history of smoking,diabetic mellitus(all P>0.05).Results of Multivariate Logistic regression analysis showed that age≥60 years,mutation load of JAK2-V617F gene≥75%,HCT≥45%,and hyperlipidemia were common risk factors for thrombosis in patients with polycythemia vera(P<0.05).Conclusions In patients with polycythemia vera,age≥60 years,mutation load of JAK2-V617F gene≥75%,HCT≥45%,and hyperlipidemia are independent risk factors for thrombosis.Therefore,the prevention should be emphasized on patients with these factors to improve their prognosis.