摘要
目的探讨序贯抗凝治疗对癌症相关急性肺血栓栓塞症的预后的影响。方法对比研究2003年3月至2013年3月就诊于中国医科大学呼吸疾病研究所并接受序贯抗凝治疗的癌症相关急性肺血栓栓塞症53例和非癌症相关急性肺血栓栓塞症168例患者的临床特征和60 d随访结果。结果癌症组患者中肺癌比例最高(24.5%),其次为结肠癌(20.8%)。两组患者在年龄、性别、体重、吸烟者比例、基础疾病和严重程度等方面差异均无统计学意义。癌症相关急性肺血栓栓塞症患者序贯抗凝治疗60 d后仍有较严重的低氧血症(P=0.006),再栓塞率和病死率均显著高于非癌症组(分别为20.8%对4.2%,26.4%对5.4%,均P<0.001)。血小板减少和出血的发生率也高于非癌症组(分别为22.6%对13.7%,24.5%对8.9%,P=0.119和0.003),两组出血发生率差异有统计学意义。结论以华法林为主的序贯抗凝治疗在癌症相关急性肺血栓栓塞症患者中治疗反应差,不良反应发生较多,病死率高,预后不佳。这类患者可能需要新的抗凝方案如低分子肝素长程抗凝治疗。
Objective To analyze the treatment response of patients with cancer associated acute pulmonary thromboembo- lism to sequential anticoagulation. Methods Compare the clinical data and 60 - day follow - up information between 53 patients of acute pulmonary thromboembolism with cancer and 168 patients of acute puhnonary thromboembolism without cancer who were all treated with sequential anticoagulation in the institute of respiratory disease of China medical university from March 2003 to March 2013. Results Pulmonary cancer was most common in the patients with cancer, and colon cancer ranked the second. There was no difference between two groups in terms of age, gender, weight, smoking status, un- derlying diseases and severity. Patients of acute pulmonary thromboembolism with cancer still had more severe hypoxemia af- ter 60-day sequential anticoagulation（ P = 0.006 ） , higher rate of recurrent embolism and mortality than control （ 20.8% vs 4. 2% ,P 〈0. 001 ;26.4% vs 5.4% ,P 〈0. 001 ）. Thrombocytopenia and bleeding were more common in patients with caner than without （22. 6% vs 13.7 % , P = 0. 119 ;24.5 % vs 8.9 % , P = 0.003 ）. Conclusion Patients of cancer-associated pul- monary thromboembolism responded badly to warfarin-based sequential antieoagulation with more adverse effects, higher mortality and worse prognosis. New protocol of anticoagulation, especially extended-period low molecular heparin might be needed for this subset of patients.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2014年第2期183-186,共4页
Chinese Journal of Practical Internal Medicine
基金
国家自然科学基金(81270146)
关键词
急性肺血栓栓塞症
癌症
抗凝
acute pulmonary thromboembolism
cancer
anticoagulation
