多发性骨髓瘤患者治疗后发生静脉血栓栓塞的危险因素

doi:10.3969/j.issn.1004-583X.2023.04.009

摘要/Abstract

摘要：

目的分析多发性骨髓瘤(multiple myeloma,MM)患者治疗后发生静脉血栓栓塞(venous thromboembolism, VTE)的危险因素。方法收集2012年1月至2022年1月于山西医科大学第一医院血液内科初治的MM患者157例。根据是否发生VTE,将患者分为非VTE组(n=124)和VTE组(n=33)。比较两组临床资料,分析MM患者治疗后发生VTE的危险因素。结果单因素分析显示,MM患者的年龄、近期手术史、近期骨折史、D-二聚体>0.55 mg/L、使用免疫调节药物、IMPEDE评分≥8分与MM患者治疗后发生VTE有关(P<0.05);二元多因素Logistic分析显示,MM患者的年龄、近期手术史、D-二聚体>0.55 mg/L、使用免疫调节药物是MM患者发生VTE的危险因素。结论评估MM患者治疗后发生VTE的风险需全面结合患者年龄、病史、实验室指标及治疗方案等情况,鉴于国外关于MM患者发生VTE相关评分可能并不完全适用于中国人群,还需进一步研究开发适用于中国MM患者发生VTE的风险评分并加以验证。

关键词: 多发性骨髓瘤, 静脉血栓栓塞, 危险因素, 免疫调节剂

Abstract:

Objective To analyze risk factors of postoperative venous thromboembolism (VTE) in multiple myeloma (MM) patients. Methods One hundred and fifty seven MM patients initially treated in the Department of Hematology, the First Hospital of Shanxi Medical University from January 2012 to January 2022 were enrolled. Patients were assigned to the non-VTE group (n=124) and VTE group (n=33) based on the existence of VTE. Clinical data of the two groups were compared, and risk factors for VTE in MM patients after treatment were analyzed. Results The results of univariate analysis showed that the age, recent surgical history, recent fracture history, D-dimer>0.55 mg/L, use of immunomodulatory drugs, and IMPEDE score ≥8 points were related to the occurrence of VTE in MM patients after treatment (P<0.05). Binary multivariate logistic analysis showed that the age, recent surgical history, D-dimer >0.55 mg/L, and use of immunomodulatory drugs were the risk factors for the occurrence of VTE in MM patients.Conclusion The assessment of the risk of VTE in MM patients after treatment should be comprehensively combined with the patient's age, medical history, laboratory indicators and treatment plan. In view of the fact that the relevant score for MM patients in foreign countries may not be fully applicable to the Chinese population, further research is needed to develop the risk score for VTE in Chinese MM patients and verify it.

Key words: multiple myeloma, venous thromboembolism, risk factors, immunomodulating agents

中图分类号:

R733.3

冷婉铜, 陶洁. 多发性骨髓瘤患者治疗后发生静脉血栓栓塞的危险因素[J]. 临床荟萃, 2023, 38(4): 340-345.

Leng Wantong, Tao Jie. Risk factors of postoperative venous thromboembolism in patients with multiple myeloma[J]. Clinical Focus, 2023, 38(4): 340-345.

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链接本文: https://lchc.magtechjournal.com/CN/10.3969/j.issn.1004-583X.2023.04.009

https://lchc.magtechjournal.com/CN/Y2023/V38/I4/340

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参考文献 29

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危险因素	评分(分)
恶性肿瘤性质
极高危(原发胃、胃食管交界处、胰腺肿瘤)	2
高危(原发肺、妇科、膀胱、睾丸肿瘤、淋巴瘤)	1
其他部位	0
化疗前白细胞计数>11×10⁹/L	1
化疗前血红蛋白<100 g/L或使用EPO	1
化疗前血小板计数>350×10⁹/L	1
BMI≥25 kg/m²	1

危险因素	评分(分)
恶性肿瘤性质
极高危(原发胃、胃食管交界处、胰腺肿瘤)	2
高危(原发肺、妇科、膀胱、睾丸肿瘤、淋巴瘤)	1
其他部位	0
化疗前白细胞计数>11×10⁹/L	1
化疗前血红蛋白<100 g/L或使用EPO	1
化疗前血小板计数>350×10⁹/L	1
BMI≥25 kg/m²	1

危险因素	评分
使用IMiDs	4
BMI≥35 kg/m²	1
近期骨折(骨盆,髋部或股骨)	4
使用EPO	1
使用多柔比星	3
使用地塞米松
高剂量(>160 mg/月)	4
低剂量(≤160 mg/月)	2
亚洲人/太平洋岛民	-3
既往VTE病史	5
留置中心静脉置管	2
使用治疗剂量的低分子肝素或华法林	-4
使用预防剂量的低分子肝素或阿司匹林	-3

危险因素	评分
使用IMiDs	4
BMI≥35 kg/m²	1
近期骨折(骨盆,髋部或股骨)	4
使用EPO	1
使用多柔比星	3
使用地塞米松
高剂量(>160 mg/月)	4
低剂量(≤160 mg/月)	2
亚洲人/太平洋岛民	-3
既往VTE病史	5
留置中心静脉置管	2
使用治疗剂量的低分子肝素或华法林	-4
使用预防剂量的低分子肝素或阿司匹林	-3

组别	例数	年龄 (岁)		性别[例(%)]				吸烟史 [例(%)]		饮酒史 [例(%)]		VTE病史 [例(%)]		慢性基础疾病史[例(%)]		BMI≥25 kg/m² [例(%)]		近期手术史 [例(%)]		近期骨折史 [例(%)]
组别	例数	年龄 (岁)		男		女		吸烟史 [例(%)]		饮酒史 [例(%)]		VTE病史 [例(%)]		慢性基础疾病史[例(%)]		BMI≥25 kg/m² [例(%)]		近期手术史 [例(%)]		近期骨折史 [例(%)]
非VTE组	124		63.59±9.80		76(61.3)		48(38.7)		34(27.4)		20(16.1)		7(5.6)		50(40.3)		32(25.8)		3(2.4)		4(3.2)
VTE组	33		67.55±10.60		17(51.5)		16(48.5)		7(21.2)		5(15.1)		4(12.1)		18(54.5)		7(21.2)		5(15.1)		8(24.2)
统计值			t=2.019		χ²=1.031				χ²=0.520		χ²=0.019		χ²=0.831		χ²=2.147		χ²=0.295		χ²=6.303		χ²=13.467
P值			0.045		0.310				0.471		0.892		0.362		0.143		0.587		0.012		0.000