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恶性肿瘤患者静脉血栓栓塞症的危险因素及生存预后:对护理和治疗的启示

The Risk Factors of VTE and Survival Prognosis of Patients With Malignant Cancer: Implication for Nursing and Treatment.

作者信息

Qi Yan, Hu Xin, Chen Jing, Ying Xiaobin, Shi Yan

机构信息

School of Medicine, Jinggangshan University, Ji An, China.

278245Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.

出版信息

Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620971053. doi: 10.1177/1076029620971053.

Abstract

Venous thromboembolism (VTE) is very common in patients with malignant cancer. We aimed to conduct a retrospective analysis on the risk factors of VTE and its survival prognosis of patients with malignant cancer, to provide evidence into the management of VTE. Patients with malignant cancer treated in our hospital were selected. The characteristic of patients and related lab detection results including activated partial thromboplastin time (APTT), plasma prothrombin time (PT) and thrombin coagulation time (TT), fibrinogen (FIB), thrombin AT-Ⅲ complex (TAT) and D-dimer (D-D) were collected and analyzed. And logistic regression analyses were performed to identify the potential risk factors. And ROC curves were established to evaluate their predictive ability of VTE for patients with malignant cancers. A total of 286 patients were included, of which 63 patients had VTE, the incidence of VTE in patients with malignant cancers was 22.03%. There were significant differences on the D-D, TAT level between VTE and no VTE patients (all P < 0.05). The survival condition of VTE patients was significantly worse than that of no VTE patients(P = 0.017). D-D (RR7.895, 3.228∼19.286) and TAT (6.122, 2.244∼16.695) were risk factors of VTE for patients with cancers (all P < 0.05). The area under the curve (AUC) of D-D, TAT and combined use was 0.764, 0.698, 0.794 respectively, and the cutoff value for D-D, TAT was 1.835mg/L and 4.58μg/L respectively. For cancer patients with D-D >1.835 mg/L and TAT >4.58 μg/L, early interventions are needed for the prophylaxis of VTE.

摘要

静脉血栓栓塞症(VTE)在恶性肿瘤患者中非常常见。我们旨在对恶性肿瘤患者VTE的危险因素及其生存预后进行回顾性分析,为VTE的管理提供依据。选取我院收治的恶性肿瘤患者。收集并分析患者的特征以及相关实验室检测结果,包括活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)、凝血酶凝固时间(TT)、纤维蛋白原(FIB)、凝血酶-抗凝血酶Ⅲ复合物(TAT)和D-二聚体(D-D)。进行逻辑回归分析以确定潜在危险因素。绘制ROC曲线以评估它们对恶性肿瘤患者VTE的预测能力。共纳入286例患者,其中63例发生VTE,恶性肿瘤患者VTE的发生率为22.03%。VTE患者和未发生VTE患者的D-D、TAT水平存在显著差异(均P<0.05)。VTE患者的生存状况明显差于未发生VTE的患者(P = 0.017)。D-D(RR7.895,3.228~19.286)和TAT(6.122,2.244~16.695)是癌症患者VTE的危险因素(均P<0.05)。D-D、TAT及联合使用的曲线下面积(AUC)分别为0.764、0.698、0.794,D-D、TAT的截断值分别为1.835mg/L和4.58μg/L。对于D-D>1.835 mg/L且TAT>4.58μg/L的癌症患者,需要早期干预以预防VTE。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c412/7607791/e6adc0269572/10.1177_1076029620971053-fig1.jpg

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