多发性骨髓瘤合并静脉血栓栓塞症的危险因素分析

Risk Factors of Multiple Myeloma Complicated with Venous Thromboembolism

目的:分析多发性骨髓瘤(MM)合并静脉血栓栓塞症(VTE)患者的临床特点,确定MM患者发生VTE的危险因素。方法:收集山西医科大学第二医院2014年1月至2020年12月收治的随访时间>6个月的新诊断的MM患者共179例,根据是否合并VTE分为VTE组和对照组。比较两组患者的临床资料及实验室指标,计量资料组间比较采用Mann-Whitney U检验,计数资料组间比较采用卡方检验或Fisher精确检验,采用多因素Logistic回归分析筛选MM并发VTE的危险因素。结果:与对照组相比,VTE组血清白蛋白水平明显降低(P=0.033),纤维蛋白原水平明显增高(P=0.016),D-二聚体≥2000ng/ml的患者比例显著高于对照组(26.3%vs 4.4%,P=0.002);两组患者间的疾病分型有显著差异(P=0.028),IgG型在VTE组中所占的比例更高。两组患者在年龄、性别、体质指数(BMI)、高血压病史、糖尿病史、冠心病史、脑梗死病史、白细胞(WBC)数、血小板(PLT)数、肝肾功能、骨髓浆细胞比例、血清球蛋白(GLO)、乳酸脱氢酶(LDH)、β2-微球蛋白(β2-MG)、C反应蛋白(CRP)、红细胞沉降率(ESR)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、临床分期、血栓预防及免疫调节药物使用方面差异均无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,纤维蛋白原水平(OR=1.578,95%CI:1.035-2.407,P=0.034)、D-二聚体≥2000 ng/ml(OR=5.467,95%CI:1.265-23.621,P=0.023)和疾病分型IgG型(OR=4.780,95%CI:1.221-18.712,P=0.025)是MM患者发生VTE的独立危险因素。结论:MM患者容易发生VTE,纤维蛋白原水平、D-二聚体≥2000 ng/ml、疾病分型IgG型是MM患者发生VTE的独立危险因素。

Objective:To analyze the clinical characteristics of venous thromboembolism(VTE)in patients with multiple myeloma(MM)and to identify the risk factors of VTE in MM patients.Methods:179 newly diagnosed MM(NDMM)patients admitted to The Second Hospital of Shanxi Medical University from January 2014 to December 2020 who were followed up for more than 6 months were collected,and they were divided into VTE group and control group according to whether combined with VTE.The clinical and laboratory data were compared between the two groups.Mann-whitney U test was used for inter-group comparison of measurement data,Chi-square test or Fisher's exact test was used for inter-group comparison of count data,and multivariate logistic regression analysis was performed to explore the risk factors of VTE in MM patients.Results:Compared with control group,the serum albumin(ALB)level in VTE group was significantly lower(P=0.033),the fibrinogen(FIB)level was significantly higher(P=0.016),and the proportion of patients with D-dimer≥2000 ng/ml was significantly higher than that in the control group(26.3%vs 4.4%,P=0.002).There was a significant difference in M-component type between the two groups(P=0.028),and the proportion of IgG type in VTE group was higher.There were no statistically significant differences between two groups in age,sex,body mass index(BMI),the proportions of patients with hypertension,diabetes,coronary heart disease and cerebral infarction,white blood cell(WBC)count,platelet(PLT)count,liver and kidney function,plasma cells ratio in bone marrow,serum globulin(GLO),lactate dehydrogenase(LDH),β2-microglobulin(β2-MG)level,C-reactive protein(CRP)level,erythrocyte sedimentation rate(ESR),prothrombin time(PT),activated partial thromboplastin time(APTT),disease stage,thrombosis prevention and the use of immunomodulators(P>0.05).Multivariate logistic regression analysis showed that FIB level(OR=1.578,95%CI:1.035-2.407,P=0.034),D-dimer≥2000 ng/ml(OR=5.467,95%CI:1.265-23.621,P=0.023)and IgG type(OR=4.780,95%CI:1.221-18.712,P=0.025)were independent risk factors for VTE in MM patients.Conclusion:MM patients are prone to VTE,and FIB level,D-dimer≥2000 ng/ml and IgG type are independent risk factors for VTE in MM patients.