免疫调节剂治疗初诊多发性骨髓瘤患者发生血栓事件的临床意义及血栓量表预测效能比较
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南京医科大学第一附属医院,江苏省人民医院血液科

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国家自然科学基金项目(面上项目,重点项目,重大项目)


The clinical significance of thrombotic events in newly diagnosed multiple myeloma patients treated with IMiDs and comparison of the predictive efficacy of thrombosis risk assessment scales.
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    摘要:

    目的:探讨静脉血栓栓塞症(VTE)对接受含免疫调节剂(IMiDs)的方案治疗的初诊多发性骨髓瘤(MM)患者预后的影响,并分析导致VTE形成的危险因素。比较Padua评分、SAVED评分与IMPEDE评分对初诊MM患者发生VTE的风险预测效能。方法:回顾性分析 2016年1月至 2022年 10月江苏省人民医院血液科应用IMiDs治疗的初诊MM患者的临床资料,并分析VTE与MM患者预后的相关性。采用Padua评分、SAVED评分及IMPEDE评分对患者进行VTE风险的量化评估,依据受试者工作特征曲线(ROC)的曲线下面积(AUC)比较三种血栓评估量表对初诊MM患者VTE发生的预测效能。结果:本研究共纳入NDMM患者221例,VTE发生率为15.8%。VTE患者中年龄超过75岁、有中心静脉置管、近期手术、制动、髓外病变、蒽环类药物应用、合并自身免疫病、低白蛋白血症的发生率较高,其中高龄、中心静脉置管、合并自身免疫病、低白蛋白血症是导致MM患者VTE发生的独立危险因素。目前最新的IMPEDE评分、SAVED评分、Padua评分在预测初诊MM患者VTE的形成的效能评估中显示IMPEDE评分优于另外两种评分体系。结论:高龄、中心静脉置管、合并自身免疫病、低白蛋白血症是导致VTE形成的独立危险因素。IMPEDE评分预测效能优于SAVED评分及Padua评分。

    Abstract:

    Objective This study aimed to examine the relationship between venous thromboembolism and the prognosis of newly diagnosed multiple myeloma (MM) treated with immunomodulatory drugs (IMiDs), and to analyze the risk factors for venous thromboembolism (VTE). To compare the predictive efficacy of the three thrombosis risk assessment scores (Padua, SAVED and IMPEDE score) in VTE in MM patients. Methods A retrospective examination was conducted on the clinical data of 221 NDMM patients treated with IMiDs at Jiangsu Provincial People's Hospital from January 2016 to October 2020, the correlation between VTE and the prognosis of MM patients was analyzed. The VTE risk of patients was quantitatively assessed with Padua, SAVED and IMPEDE scores. The predictive value of the three scales for VTE was compared based on the area under the ROC curve (AUC). Results Of the 221 patients, the incidence of VTE was 15.8%. Patients with age over 75 years, central venous catheterization (CVC), recent surgery, braking on the bed, extramedullary disease, anthracycline using, autoimmune disease and hypoalbuminemia had a higher incidence of VTE. Age over 75 years, CVC, autoimmune disease and hypoalbuminemia were independent unfavorable factors for VTE. Among Paudua, SAVED, and IMPEDE scores, IMPEDE score is superior to the other two scores in efficacy evaluation of predicting the formation of VTE in newly diagnosed MM patients. Conclusion Age over 75 years, CVC, autoimmune disease and hypoalbuminemia were independent unfavorable factors for VTE. IMPEDE score is suitable for predicting VTE in patients with NDMM.

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  • 收稿日期:2024-10-27
  • 最后修改日期:2025-02-22
  • 录用日期:2025-04-28
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