骨髓增殖性肿瘤患者发生血栓事件的危险因素
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摘要
目的:分析研究骨髓增殖性肿瘤(MPN)患者发生血栓事件的危险因素。方法:对391例骨髓增值性肿瘤患者出现血栓事件的情况进行综合分析,其中男195例,年龄15～72岁,平均年龄56岁;女196例,年龄16～60岁,平均年龄48岁。结果:①所有MPN患者中105例发生血栓事件,血栓发生率为26.9%(105/391)。血栓发生率在男女性别之间差异无统计学意义(X~2=0.59,P>0.05);而年龄≥45岁的患者高于年龄<45岁的患者,差异有统计学意义(X~2=16.81,P<0.05);JAK2-V617F阳性的患者高于阴性患者,差异有统计学意义(X~2=23.59,P<0.05);外周血白细胞数量≥10×10~9/L的患者高于白细胞<10×10~9/L的患者,差异有统计学意义(X~2=28.3,P<0.05);外周血血小板数量≥300×10~9/L的患者高于血小板数量<300×10~9/L的患者,差异有统计学意义(X~2=29.14,P<0.05);外周血血红蛋白含量≥160g/L的患者高于血红蛋白含量<160g/L的患者,差异有统计学意义(X~2=30.58,P<0.05)。②采用多因素Logistic回归分析方法,以年龄、性别、白细胞、血小板、血红蛋白、JAK2-V617F阳性为自变量,以血栓为因变量,结果显示:高龄、高白细胞计数、高血小板计数、高血红蛋白含量、JAK2-V617F突变阳性是血栓事件发生的危险因素。结论:MPN患者容易发生血栓事件,对于骨髓增值性肿瘤患者临床出现引发血栓的危险因素时,需要提高注意,应提早采取措施。
Objective:to analyze and study the risk factors of thrombotic events in patients with myeloproliferative neoplasms.Methods:The incidence of thrombotic events in 391 patients with bone marrow proliferative tumors was analyzed. Among them, 195 were males, aged from 14 to 70 years, with a median age of 55 years. There were 196 women, aged 18～61 years, with a median age of 50 years.Results:among 391 patients with MPN, 105 had thromboembolic events, and the incidence of thrombosis was 26.9%(105/391). There was no significant difference in the incidence of thrombosis between men and women(χ~(2 )= 0.59, P> 0.05); however, the incidence of thrombosis was significantly higher in patients older than 45 years than in patients younger than 45 years(X~2 = 16.81, P<0.05); the incidence of thrombosis in JAK2-V617 F positive patients was significantly higher than that in negative patients(X~2 = 23.59, P<0.05); the incidence of thrombosis in patients older than 45 years was significantly higher than that in patients younger There was a significant difference between the patients whose number of cells was more than 10×10~9/L and those whose white blood cells were less than 10×10~9/L(X~2 = 28.3, P<0.05); the patients whose number of peripheral blood platelets was more than 300×10~9/L were higher than those whose number of platelets was less than 300×10~9/L(X~2 = 29.14, P<0.05); and the patients whose hemoglobin content was more than 160 g/L. The difference was statistically significant(X~2 = 30.58, P<0.05) between the patients with higher hemoglobin content<160 g/L. Multivariate logistic regression analysis was performed with thrombotic events as dependent variables and sex, age, JAK2-V617 F positive, leukocyte, hemoglobin and platelet as independent variables. The results showed that the occurrence of thrombotic events was related to the age, JAK2 V617 F positive, high leukocyte count, high hemoglobin content and high platelet count. Risk factors.Conclusions:Patients with MPN are prone to thrombotic events. It is necessary to pay more attention to the risk factors of thrombosis in patients with myeloproliferative tumors and take early measures.
Objective:to analyze and study the risk factors of thrombotic events in patients with myeloproliferative neoplasms.Methods:The incidence of thrombotic events in 391 patients with bone marrow proliferative tumors was analyzed. Among them, 195 were males, aged from 14 to 70 years, with a median age of 55 years. There were 196 women, aged 18～61 years, with a median age of 50 years.Results:among 391 patients with MPN, 105 had thromboembolic events, and the incidence of thrombosis was 26.9%(105/391). There was no significant difference in the incidence of thrombosis between men and women(χ~(2 )= 0.59, P> 0.05); however, the incidence of thrombosis was significantly higher in patients older than 45 years than in patients younger than 45 years(X~2 = 16.81, P<0.05); the incidence of thrombosis in JAK2-V617 F positive patients was significantly higher than that in negative patients(X~2 = 23.59, P<0.05); the incidence of thrombosis in patients older than 45 years was significantly higher than that in patients younger There was a significant difference between the patients whose number of cells was more than 10×10~9/L and those whose white blood cells were less than 10×10~9/L(X~2 = 28.3, P<0.05); the patients whose number of peripheral blood platelets was more than 300×10~9/L were higher than those whose number of platelets was less than 300×10~9/L(X~2 = 29.14, P<0.05); and the patients whose hemoglobin content was more than 160 g/L. The difference was statistically significant(X~2 = 30.58, P<0.05) between the patients with higher hemoglobin content<160 g/L. Multivariate logistic regression analysis was performed with thrombotic events as dependent variables and sex, age, JAK2-V617 F positive, leukocyte, hemoglobin and platelet as independent variables. The results showed that the occurrence of thrombotic events was related to the age, JAK2 V617 F positive, high leukocyte count, high hemoglobin content and high platelet count. Risk factors.Conclusions:Patients with MPN are prone to thrombotic events. It is necessary to pay more attention to the risk factors of thrombosis in patients with myeloproliferative tumors and take early measures.
引文
[1] Vainchenker W, Kralovics R.Cenetic basis and molecular pathophysiology of classical myeloproliferative neoplasms[J].Blood, 2017, 129(6): 667.
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[8] Wolach O, Sellar RS, Martinod K, et al. Increased neutrophil extracellular trap formation promotes thrombosis in myeloproliferative neoplasms [J].Sci Transl Med, 2018, 436(10): 1946-2634.
[9] Lamy M, Palazzo P, Agius P, et al. Should we screen for janus kinase 2 V617F mutation in cerebral venous thrombosis [J].Cerebrovasc Dis,2017 , 44(3-4):97-104.
[10] Andlc N,Unubol M,Yagcl E, et al. Clinical features of 294 turkish patients with chronic myeloproliferative neoplasms [J].Turk J Haematol, 2016, 33(3):187-195.
[11] 吴鸿飞,谢新生,刘柳,等. Bcr-abl阴性骨髓增殖性肿瘤患者基因突变及合并血栓的危险因素分析[J]. 白血病·淋巴瘤,2017,26(8):461-462.
[12] 孙福全,刘南,陈伟伟. Ph阴性MPN患者JAK2、CALR或MPL基因突变检测及临床分析[J]. 中外医疗,2018,37(2):24-29.
[13] 刘俊秀,陈伟,徐开林. JAK2抑制剂在骨髓纤维化治疗中研究进展[J]. 中国血液实验室杂志,2018,26(1):283-286.
[14] 杨志瑞,朱海燕. 芦可替尼治疗骨髓增殖性肿瘤安全性和有效性的Meta分析[J]. 中国血液实验室杂志,2018,26(2):493-501.
[2] Zimran E, Hoffman R, Kremyanskaya M. Current approaches to challenging scenarios in myeloproliferative neoplasms [J].Expert Rev Anticancer Ther, 2018, 18(6): 567-578.
[3] Takata Y, Seki R, Kanaji T, et al. Association between thromboembolic events and the JAK2 V617F mutation in myeloproliferative neoplasms [J].Kurume Med J, 2014 , 60(3-4):89-97.
[4] Danlel A, Attilio O, Robert H, et al. The 2016 revision tothe World Health Organization classification of myeloid neoplasms and acute leukemia [J]. Blood, 2016, 127(20):2391-2405.
[5] Haybar H, Khodadi E, Shahjahani M, et al. Cardiovascular events: A challenge in JAK2-positive myeloproliferative neoplasms [J].Cardiovasc Hematol Disord Drug Targets, 2017, 17(3):161-166.
[6] Ball S, Thein KZ, Maiti A, et al. Thrombosis in Philadelphia negative classical myeloproliferative neoplasms: a narrative review on epidemiology, risk assessment, and pathophysiologic mechanisms [J].J Thromb Thrombolysis, 2018, 45(4): 516-528.
[7] Guadall A, Lesteven E, Letort G, et al. Endothelial cells harbouring the JAK2V617F mutation display Pro-adherent and Pro-thrombotic features [J].Thromb Haemost, 2018, 118(8): 6240-6245.
[8] Wolach O, Sellar RS, Martinod K, et al. Increased neutrophil extracellular trap formation promotes thrombosis in myeloproliferative neoplasms [J].Sci Transl Med, 2018, 436(10): 1946-2634.
[9] Lamy M, Palazzo P, Agius P, et al. Should we screen for janus kinase 2 V617F mutation in cerebral venous thrombosis [J].Cerebrovasc Dis,2017 , 44(3-4):97-104.
[10] Andlc N,Unubol M,Yagcl E, et al. Clinical features of 294 turkish patients with chronic myeloproliferative neoplasms [J].Turk J Haematol, 2016, 33(3):187-195.
[11] 吴鸿飞,谢新生,刘柳,等. Bcr-abl阴性骨髓增殖性肿瘤患者基因突变及合并血栓的危险因素分析[J]. 白血病·淋巴瘤,2017,26(8):461-462.
[12] 孙福全,刘南,陈伟伟. Ph阴性MPN患者JAK2、CALR或MPL基因突变检测及临床分析[J]. 中外医疗,2018,37(2):24-29.
[13] 刘俊秀,陈伟,徐开林. JAK2抑制剂在骨髓纤维化治疗中研究进展[J]. 中国血液实验室杂志,2018,26(1):283-286.
[14] 杨志瑞,朱海燕. 芦可替尼治疗骨髓增殖性肿瘤安全性和有效性的Meta分析[J]. 中国血液实验室杂志,2018,26(2):493-501.