摘要
目的分析恶性肿瘤相关单纯下肢远端深静脉血栓形成(IDDVT)患者的临床特点及预后。方法对2003年1月至2013年1月北京医院64例恶性肿瘤合并IDDVT患者的临床资料进行回顾性分析,分析其临床特点和预后。结果64例患者中男、女各32例,年龄37~87岁,平均(66.0±12.6)岁,≥65岁组42例,<65岁组22例。常见症状为下肢肿胀或疼痛(53.1%)。64例患者中累及单侧下肢47例,双侧17例,累及肌间静脉46例(71.9%)、胫后静脉17例(26.6%)、腓静脉14例(21.9%)、胫前静脉2例(3.1%)。85.9%(55例)的患者行抗凝治疗,2例(3.6%)发生出血,未发生大出血事件。自肿瘤确诊后3、6、12个月IDDVT累积发生率分别为64.0%(41例)、75.0%(48例)、85.9%(55例),肺癌肿瘤确诊3、6个月IDDVT累积发病率高于消化道肿瘤(P=0.005和0.035)。截至随访结束(中位随访时间13.0个月)共30例(46.9%)死亡。非老年组病死率(22.7%)低于老年组(59.5%)(χ^2=7.850,P=0.005),Ⅰ-Ⅲa期患者病死率(24.0%)低于Ⅲb-Ⅳ期患者(68.8%)(χ^2=11.246,P=0.001);妇科肿瘤患者病死率(10.0%)低于肺癌(55.6%)、消化道肿瘤(40.0%)及血液肿瘤组患者(71.4%)(P=0.041、0.037和0.035)。TNM Ⅲb-Ⅳ期(OR=8.42,95%CI:1.93~30.00,P=0.004)及年龄≥65岁(OR=6.28,95%CI:1.50~27.76,P=0.012)是死亡的独立危险因素。结论肿瘤相关IDDVT最常累及肌间静脉,抗凝治疗后出血的发生率较低,对于无抗凝禁忌的患者应积极抗凝治疗;肿瘤晚期及老年是肿瘤相关IDDVT死亡的独立危险因素。
Objective To investigate clinical features and prognosis of patients with cancer-related isolated distal deep vein thrombosis(IDDVT). Methods Data of 64 patients with malignant tumor complicated with IDDVT at our hospital from January 2003 to January 2013 were retrospectively analyzed for the clinical features and prognosis. Results Among the 64 patients, 32 male and 32 female cases were involved, aged 37 to 87 years, average(66.0±12.6)years.There were 42 cases aged 65 years and older and 22 cases aged under 65 years.The IDDVT involved veins of lower extremity in 64 patients, unilaterally(47/64)or bilaterally(17/64). The intermuscular veins were involved by IDDVT in 46 cases(71.9%). Posterior tibial veins were involved in 17 cases(26.6%), peroneal veins were involved in 14 cases(21.9%), anterior tibial veins were involved in 2 cases(3.1%). Common symptoms were swollen lower extremity and pain(53.1%). Bleeding occurred in 2(3.6%)of the 55 patients(55/64, 85.9%)who underwent anticoagulant therapy, and no major bleeding occurred.The cumulative incidence of IDDVT at 3, 6, and 12 months after tumor diagnosis was 64.0%(41/64 cases), 75.0%(48/64 cases)and 85.9%(55/64 cases), respectively.The cumulative incidences of IDDVT at 3 and 6 months were higher after diagnosis of lung cancer than after diagnosis of digestive tract tumors(P=0.005 and 0.035). By the end of follow-up(a median follow-up of 13.0 months), 30 patients(46.9%)died.The mortality rate was lower in the non-elderly group than in the elderly group(22.7% vs.59.5%,χ^2=7.850, P=0.005). The mortality rate was lower in patients with stage I-Ⅲa than in patients with stage Ⅲb-Ⅳ(24.0% vs.68.8%,χ^2=11.246, P=0.001). The mortality rate was lower in patients with gynecologic tumors(10.0%)than in patients with lung cancer(55.6%), digestive tract tumors(40.0%)and hematologic tumors(71.4%)(P=0.041, 0.037 and 0.035, respectively). TNM Ⅲb-Ⅳ(OR=8.42, 95%CI: 1.93-30.00, P=0.004)and age≥65 years(OR=6.28, 95%CI: 1.50-27.76, P=0.012)were independent risk factors for
作者
乔力松
杨鹤
方保民
谭政
许小毛
Qiao Lisong;Yang He;Fang Baomin;Tan Zheng;Xu Xiaomao(Division of Respiratory and Critial Care Medicine, Beijing Hospital, National Center of Gerontology, Beijing 100730, China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2019年第6期644-648,共5页
Chinese Journal of Geriatrics
基金
国家重点研发计划(2016YFC0905602)
国家科技支撑计划(2011BAI11B17).
关键词
肿瘤
静脉血栓形成
下肢
Neoplasms
Venous thrombosis
Lower extremity
