摘要
目的通过对静脉置管化疗乳腺癌患者早期发生导管相关血栓(catheter-related thrombosis,CRT)的临床资料回顾性总结,分析CRT的危险因素,并为临床制定预防措施提供依据。方法收取2016年1月至2016年9月重庆医科大学附属第一医院内分泌乳腺外科收治的312名乳腺癌患者作为研究对象进行回顾性分析。应用单因素分析及多因素Logistic回归分析静脉置管化疗乳腺癌患者早期发生CRT的危险因素,并采用ROC曲线评价Logistic回归模型的效果。结果入组的312例患者,在诊断乳腺癌早期(3个月内)发生血栓的例数为193例,发生率为62%。单因素分析显示年龄(c2=8.502;P<0.05)及体重指数(c2=5.909;P<0.1)与静脉置管化疗乳腺癌患者早期发生CRT有关。而预防性抗凝、入院的全身炎症水平及是否行乳腺癌手术比较,差异无统计学意义。多因素分析结果显示年龄及肥胖(BMI≥28 kg/m2)[OR=2.611,95%CI(1.060～6.429)]为静脉置管化疗乳腺癌患者早期发生CRT的独立危险因素,其中41～60岁[OR=2.3,95%CI(1.242～4.260)];>60岁[OR=2.758,95%CI(1.232～6.174)]。绘制受试者工作特征(receiver operating characteristics,ROC)曲线评价Logistic回归模型效果,其曲线下面积(area under cure,AUC)为0.618,95%CI(0.555～0.681),预测CRT的特异性和敏感性较低。结论本研究显示静脉置管化疗乳腺癌患者早期CRT的发生率较高,年龄和肥胖为静脉置管化疗乳腺癌患者早期发生CRT的独立危险因素,且对所有患者行预防性抗凝治疗并无明显获益。
Objective To investigate the risk factors of catheter-related thrombosis(CRT) at early stage in breast cancer undergoing chemotherapy through central venous catheters and provide measures for early prevention. Methods A total of 312 breast cancer patients who suffered from CRT in the First Affiliated Hospital of Chongqing Medical University from January 2016 to September 2016 were recruited. Clinical data of the patients were retrospectively analyzed. Univariate analysis and multivariate Logistic regression analysis were used to analyze the risk factors of catheter-related thrombosis at early stage in breast cancer patients undergoing chemotherapy through central venous catheters, and the effect of Logistic regression model was evaluated by receiver operating characteristics(ROC) curve. Results There were 193 cases with CRT in breast cancer undergoing chemotherapy through central venous catheters within 3 months, the incidence of CRT was 62%(193/312). Univariate analysis showed that age(c2=8.502, P<0.05)and BMI(c2=5.909;P<0.1)were associated with an increased risk ofCRT. Prophylaxis with anticoagulant, systemic inflammation and surgery did not influence the occurrence of CRT between the two groups. In the multivariate analysis, 41-60 years old [OR=2.3, 95%CI(1.242-4.260)], over the age of 60 [OR=2.758, 95%CI(1.232-6.174)] and obesity [OR=2.611, 95%CI(1.060-6.429)] were independent risk factors for CRT. The ROC curve analysis showed area under curve of the Logistic regression model 0.618,95%CI(0.555-0.681), which demonstrated the specificity and sensitivity in predicting CRT were low. Conclusion The incidence of CRT at early stage was relatively high in breast cancer undergoing chemotherapy through central venous catheters. Age and obesity were the independent risk factors for CRT. And there was no significant benefit for all breast cancer to take prophylactic anticoagulant therapy.
引文
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