运用主成分分析及二元多因素logistic回归模型分析恶性实体肿瘤患者血栓前状态发生的影响因素
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摘要
目的筛查恶性实体肿瘤患者血栓前状态(PTS)发生的影响因素。方法回顾分析新疆维吾尔自治区人民医院2016年12月—2017年6月入住放疗二科的102例恶性实体肿瘤患者的临床及实验室资料,其中处于PTS的患者67例,其余35例为非PTS的患者。采用主成分分析、单因素分析及多因素logistic回归模型对PTS的影响因素进行分层分析。结果①处于PTS的恶性实体肿瘤患者存在血常规及凝血功能等指标异常(P<0.05);②单因素分析显示PTS在年龄、肿瘤分期、治疗与否、长期卧床、PICC、预防性抗凝以及白细胞计数、血红蛋白、血小板计数、红细胞压积、FIB、D-D等变量中差异均有统计学意义(均P<0.05);③多因素logistic回归模型分析显示PTS在KPS评分、预防性抗凝、长期卧床、PICC等变量因素中差异均有统计学意义(均P<0.05)。结论①PTS的危险因素包括WBC、PLT计数、FIB、D-D等(均P<0.05),而预防性抗凝KPS评分为PTS的保护性因素;②PTS在不同部位恶性实体肿瘤患者中差异无统计学意义(P>0.05);③传统的抗肿瘤治疗既可降低肿瘤负荷,亦可增加PTS发生的风险。④应对长期卧床及置入PICC的恶性实体肿瘤患者给予高度重视。
Objective To screening the possible risk factors of pre-thrombotic state(PTS) in patients with malignant solid tumor. Methods The clinical and laboratory data of 102 cases of malignant solid tumor in our department between December 2016 and June 2017, including 67 patients with PTS and 35 patients without PTS, were retrospectively analyzed. The stratified analyses by principal component analysis, single factor analysis and Multivariate logistic regression analysis was conducted for the risk factors of PTS in patients with malignant solid tumor. Results ①The malignant solid tumor patients in PTS were with abnormal values in laboratory routine blood and blood coagulation test; ②The single factor analysis showed that the age, tumor staging, treatment, long-term lie in bed, PICC, prophylactic anticoagulation, and laboratory parameters such as white blood cell count, hemoglobin, platelet count, erythrocyte deposited and FIB, D-D variables were all correlated with PTS(all P<0.05); ③The multivariate logistic regression analysis showed that KPS score, tumor staging, prophylactic anticoagulation, long-term lie in bed and PICC were risk factors of PTS, all P<0.05. Conclusion ①The risk factors for PTS include the WBC, PLT count, FIB, D-D, KPS score etc. The prophylactic anticoagulation is the protective factor of PTS. ②PTS varies with the location of malignant solid tumors in different parts of the body, but the difference was not statistically slgnificant(P>0.05). ③Traditional antitumor treatment can reduce the tumor load; however, it also increases the risk of PTS. ④More attentions should be paid for the long-term lie in bed patients and those patients with PICC.
Objective To screening the possible risk factors of pre-thrombotic state(PTS) in patients with malignant solid tumor. Methods The clinical and laboratory data of 102 cases of malignant solid tumor in our department between December 2016 and June 2017, including 67 patients with PTS and 35 patients without PTS, were retrospectively analyzed. The stratified analyses by principal component analysis, single factor analysis and Multivariate logistic regression analysis was conducted for the risk factors of PTS in patients with malignant solid tumor. Results ①The malignant solid tumor patients in PTS were with abnormal values in laboratory routine blood and blood coagulation test; ②The single factor analysis showed that the age, tumor staging, treatment, long-term lie in bed, PICC, prophylactic anticoagulation, and laboratory parameters such as white blood cell count, hemoglobin, platelet count, erythrocyte deposited and FIB, D-D variables were all correlated with PTS(all P<0.05); ③The multivariate logistic regression analysis showed that KPS score, tumor staging, prophylactic anticoagulation, long-term lie in bed and PICC were risk factors of PTS, all P<0.05. Conclusion ①The risk factors for PTS include the WBC, PLT count, FIB, D-D, KPS score etc. The prophylactic anticoagulation is the protective factor of PTS. ②PTS varies with the location of malignant solid tumors in different parts of the body, but the difference was not statistically slgnificant(P>0.05). ③Traditional antitumor treatment can reduce the tumor load; however, it also increases the risk of PTS. ④More attentions should be paid for the long-term lie in bed patients and those patients with PICC.
引文
[1] STIEFELHAGEN P.Patient with colon carcinoma and venous thrombosis.What anticoagulation would you prescribe for hematologic disorder?[J].MMW Fortschr Med,2014,156(20):28.
[2] 马军,吴一龙,秦叔逵,等.中国肿瘤相关静脉血栓栓塞症预防与治疗专家指南(2015版)[J].中国实用内科杂志,2015,35(11):907-920.
[3] WATSON H G,KEELING D M,LAFFAN M,et al.Guideline on aspects of cancer-related venous thrombosis[J].Br J Haematol,2015,170(5):640-648.
[4] 丁洁,崔林.肺癌前血栓状态的研究进展[J].现代肿瘤医学,2016,24(19):3154-3157.
[5] MADRIDANO O,DEL TORO J,LORENZO A,et al.Subsequent arterial ischemic ischemic events in patients receiving anticoagulant therapy for venous thromboembolism[J].J Vasc Surg Venous Lymphat Disord,2015,3(2):135-141.
[6] FALZ A S,KHAN I,BECKMAN M G,et al.Characteristics and risk factors of cancer associated venous thromboembolism[J].Thromb Res,2015,136(3):535-541.
[7] ASHRANI A A,GULLERUD R E,PETTERSON T M,et al.Risk factors for incident venous thromboembolism in active cancer patients:A population based case-control study[J].Thromb Res,2016,139:29-37.
[8] 崔林,陈珏,孙友红,等.抗凝治疗在恶性肿瘤前血栓状态中的应用[J].现代肿瘤医学,2016,24(3):468-471.
[9] 李金玲,代俊利,姜峰,等.肺癌合并静脉血栓栓塞症37例临床调查分析[J].重庆医学,2015,44 (34):4790-4792,4795.
[10] 陈晓燕.恶性肿瘤化疗患者PICC置管术后静脉血栓形成的原因及预防对策[J].临床合理用药杂志,2017,10(28):152-153.
[11] 张秀玲,柳建华.彩超对肿瘤患者PICC术后上肢静脉血栓的诊断价值[J].临床医学工程,2015,22(2):153-154,159.
[12] ITKIN M,MONDSHEIN J I,STAVROPOULOS S W,et al.Peripherally inserted central catheter thrombosis-reverse tapered versus nontapered catheters:a randomized controlled study[J].J Vasc Interv Radiol,2014,25(1):85-91.
[13] LIU Y,GAO Y,WEI L,et al.Peripherally inserted central catheter thrombosis incidence and risk factors in cancer patients:a double-center prospective investigation[J].Ther Clin Risk Manag,2015,11:153-160.
[14] LEE Y G,LEE E,LEE K W,et al.Cisplatin-based chemotherapy is a strong risk factor for thromboembolic events in small cell lung cancer[J].Cancer Res Treat,2015,10(4):4143-4148.
[15] 李进,秦叔逵,马军,等.肿瘤内科诊治策略[M].上海:上海科学技术出版社,2017:271.
[2] 马军,吴一龙,秦叔逵,等.中国肿瘤相关静脉血栓栓塞症预防与治疗专家指南(2015版)[J].中国实用内科杂志,2015,35(11):907-920.
[3] WATSON H G,KEELING D M,LAFFAN M,et al.Guideline on aspects of cancer-related venous thrombosis[J].Br J Haematol,2015,170(5):640-648.
[4] 丁洁,崔林.肺癌前血栓状态的研究进展[J].现代肿瘤医学,2016,24(19):3154-3157.
[5] MADRIDANO O,DEL TORO J,LORENZO A,et al.Subsequent arterial ischemic ischemic events in patients receiving anticoagulant therapy for venous thromboembolism[J].J Vasc Surg Venous Lymphat Disord,2015,3(2):135-141.
[6] FALZ A S,KHAN I,BECKMAN M G,et al.Characteristics and risk factors of cancer associated venous thromboembolism[J].Thromb Res,2015,136(3):535-541.
[7] ASHRANI A A,GULLERUD R E,PETTERSON T M,et al.Risk factors for incident venous thromboembolism in active cancer patients:A population based case-control study[J].Thromb Res,2016,139:29-37.
[8] 崔林,陈珏,孙友红,等.抗凝治疗在恶性肿瘤前血栓状态中的应用[J].现代肿瘤医学,2016,24(3):468-471.
[9] 李金玲,代俊利,姜峰,等.肺癌合并静脉血栓栓塞症37例临床调查分析[J].重庆医学,2015,44 (34):4790-4792,4795.
[10] 陈晓燕.恶性肿瘤化疗患者PICC置管术后静脉血栓形成的原因及预防对策[J].临床合理用药杂志,2017,10(28):152-153.
[11] 张秀玲,柳建华.彩超对肿瘤患者PICC术后上肢静脉血栓的诊断价值[J].临床医学工程,2015,22(2):153-154,159.
[12] ITKIN M,MONDSHEIN J I,STAVROPOULOS S W,et al.Peripherally inserted central catheter thrombosis-reverse tapered versus nontapered catheters:a randomized controlled study[J].J Vasc Interv Radiol,2014,25(1):85-91.
[13] LIU Y,GAO Y,WEI L,et al.Peripherally inserted central catheter thrombosis incidence and risk factors in cancer patients:a double-center prospective investigation[J].Ther Clin Risk Manag,2015,11:153-160.
[14] LEE Y G,LEE E,LEE K W,et al.Cisplatin-based chemotherapy is a strong risk factor for thromboembolic events in small cell lung cancer[J].Cancer Res Treat,2015,10(4):4143-4148.
[15] 李进,秦叔逵,马军,等.肿瘤内科诊治策略[M].上海:上海科学技术出版社,2017:271.