纤溶酶原激活物抑制剂-1 基因启动子 4G/5G 多态性与肺癌患者经外周中心静脉置管相关静脉血栓形成风险的前瞻性队列研究。
Plasminogen activator inhibitor-1 gene promoter 4G/5G polymorphism and risks of peripherally inserted central catheter-related venous thrombosis in patients with lung cancer: a prospective cohort study.
机构信息
West China School of Nursing/Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, 610041, China.
Department of Thoracic Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China.
出版信息
Support Care Cancer. 2021 Nov;29(11):6431-6439. doi: 10.1007/s00520-021-06207-8. Epub 2021 Apr 24.
PURPOSE
This study investigated the influence of plasminogen activator inhibitor-1 (PAI-1) gene polymorphisms and other contributing clinical factors on peripherally inserted central catheter-related venous thrombosis (PICC-RVT) in Chinese patients with lung cancer.
METHODS
We conducted a prospective study of 237 participants. Blood samples were collected to detect the PAI-1 4G/5G genotype. Venous thromboembolism risk was calculated by the Caprini risk assessment model. Color Doppler ultrasonography was performed every 7 days for 3 weeks to confirm PICC-RVT.
RESULTS
The rate of PICC-RVT was 13.50% (32/237). The 5G/5G, 4G/5G, and 4G/4G genotypes were found in 12.50% vs 17.56%, 59.38% vs 49.27%, and 28.12% vs 34.17% in the thrombus group and the non-thrombus group of the participants. No difference was observed in the distribution frequency of the three genotypes between the thrombus and non-thrombus groups. A higher fibrinogen level (OR 1.194, 95% CI 1.004-1.420, P = 0.045) and a higher Caprini score (OR 1.698, 95% CI 1.103-2.614, P = 0.016) were statistically significant risk factors for PICC-RVT. Compared with patients who underwent a pemetrexed/cisplatin regimen, those who were administered paclitaxel/cisplatin (OR 18.332, 95% CI 2.890-116.278, P = 0.002) or gemcitabine/cisplatin (OR 6.617, 95% CI 1.210-36.180, P = 0.029) were at increased risk of PICC-RVT.
CONCLUSION
Our finding suggested that there is no statistically significant influence of the PAI-1 4G/5G gene variant on PICC-RVT in Chinese patients with lung cancer. However, patients with higher Caprini scores and higher fibrinogen levels are at increased risk for PICC-RVT, as are patients receiving chemotherapy. Clinical staff should carefully perform a risk assessment for patients with PICC. Those with the above risk factors should pay close attention and take timely and effective preventive measures.
目的
本研究旨在探讨纤溶酶原激活物抑制剂-1（PAI-1）基因多态性及其他临床相关因素对中国肺癌患者经外周静脉置入中心静脉导管相关静脉血栓形成（PICC-RVT）的影响。
方法
我们进行了一项前瞻性研究，共纳入 237 例参与者。采集血样检测 PAI-1 4G/5G 基因型。采用卡普里风险评估模型计算静脉血栓栓塞风险。在 3 周内每 7 天进行彩色多普勒超声检查以确认 PICC-RVT。
结果
PICC-RVT 的发生率为 13.50%（32/237）。血栓组和非血栓组参与者中，5G/5G、4G/5G 和 4G/4G 基因型的分布频率分别为 12.50%比 17.56%、59.38%比 49.27%和 28.12%比 34.17%。血栓组和非血栓组 3 种基因型的分布频率无差异。纤维蛋白原水平较高（OR 1.194，95%CI 1.004-1.420，P=0.045）和卡普里评分较高（OR 1.698，95%CI 1.103-2.614，P=0.016）是 PICC-RVT 的统计学显著危险因素。与接受培美曲塞/顺铂方案治疗的患者相比，接受紫杉醇/顺铂（OR 18.332，95%CI 2.890-116.278，P=0.002）或吉西他滨/顺铂（OR 6.617，95%CI 1.210-36.180，P=0.029）化疗的患者发生 PICC-RVT 的风险增加。
结论
我们的研究结果表明，纤溶酶原激活物抑制剂-1 4G/5G 基因变异对中国肺癌患者 PICC-RVT 无统计学显著影响。然而，Caprini 评分较高和纤维蛋白原水平较高的患者发生 PICC-RVT 的风险增加，接受化疗的患者也是如此。临床工作人员应仔细对 PICC 患者进行风险评估。具有上述危险因素的患者应密切关注并及时采取有效预防措施。
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