骨髓增殖性肿瘤患者血栓/出血事件的影响因素分析及其风险预测

Risk Prediction and Risk Factors of Thrombotic/Bleeding Events in Patients with Myeloproliferative Neoplasm

目的:分析骨髓增殖性肿瘤(MPN)患者的临床特征、血栓/出血事件的发生情况,探讨其影响因素并进行风险预测。方法:收集2016年1月至2021年9月就诊于甘肃省人民医院血液科的126例BCR-ABL融合基因阴性的MPN患者的临床资料,对其临床特征、血栓/出血事件发生情况及影响因素进行回顾性分析和总结,并构建风险预测模型。结果:在126例MPN患者中,50例(39.7%)发生过血栓/出血事件,其中发生血栓事件44例(34.9%),出血事件6例(4.8%)。血栓性疾病中以脑血栓最常见(23/44,52.3%),其次是以指端和趾端动脉缺血、闭塞和坏疽为主要表现的四肢动脉血栓,共9例(9/44,20.5%);出血事件包括脑出血和胃肠道出血。单因素分析结果表明,高血压病史、高同型半胱氨酸血症、白细胞计数≥10×10^(9)/L、血细胞比容≥49%、血小板计数≥600×10^(9)/L以及JAK2V617F基因突变是MPN患者发生血栓/出血事件的危险因素,而CALR基因突变是保护性因素。多因素分析结果表明,高血压病史和血小板计数≥600×10^(9)/L为MPN患者发生血栓/出血事件的独立危险因素。构建的风险预测模型拟合优度P=0.872,ROC曲线下面积为0.838。临床验证模型预测的灵敏度为78.85%,特异度为87.83%,准确率为84.13%。结论:高白细胞计数伴有高血压和高同型半胱氨酸血症的MPN患者发生血栓/出血事件的风险更高,控制高血压及高同型半胱氨酸血症,降低白细胞和血小板数,有助于预防血栓/出血事件的发生,从而提高患者生存质量。

Objective:To analyze the clinical characteristics and occurrence of thrombotic/bleeding events of patients with myeloproliferative neoplasm(MPN),and explore the main influencing factors,and create a risk prediction.Methods:The clinical data of 126 MPN patients with BCR-ABL fusion gene negative in the Department of Hematology of Gansu Provincial Hospital from January 2016 to September 2021 were collected,and their clinical characteristics,occurrence of thrombotic/bleeding events and main influencing factors were analyzed and summarized retrospectively.Then,a risk prediction model for thrombotic/bleeding events in MPN patients was constructed.Results:Among 126 MPN patients,50 patients(39.7%)had experienced thrombotic/bleeding events,including 44 patients(34.9%)with thrombotic events and 6 patients(4.8%)with bleeding events.Among thrombotic diseases,cerebral thrombosis was the most common(23/44,52.3%),followed by 9 cases of limb artery thrombosis mainly characterized by finger and toe tip artery ischemia,occlusion and gangrene(9/44,20.5%).Bleeding events included intracerebral hemorrhage and gastrointestinal hemorrhage.Univariate analysis showed that hypertension,hyperhomocysteinemia,white blood cell(WBC)≥10×10^(9)/L,hematocrit(HCT)≥49%,platelet(PLT)≥600×10^(9)/L and JAK2V617F gene mutation were risk factors for thrombotic/bleeding events in MPN patients,while CALR gene mutation was a protective factor.Multivariate analysis showed that hypertension and PLT≥600×10^(9)/L were independent risk factors for thrombotic/bleeding events in MPN patients.The goodness of fit of the constructed risk prediction model was 0.872,and the area under the ROC curve was0.838.The model was validated with clinical data,the sensitivity,specificity and accuracy was78.85%,87.83%and84.13%,respectively.Conclusion:The risk of thrombotic/bleeding events in MPN patients with high WBC count,hypertension and hyperhomocysteinemia is higher.Controlling hypertension and hyperhomocysteinemia and reducing WBC and PLT counts are helpful to prevent thrombotic/bleeding events and improve the life quality of patients.