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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 investigate the effect of sequential anticoagulant therapy on the prognosis of cancer-related acute pulmonary thromboembolism. Methods A comparative study was conducted between March 2003 and March 2013 in 53 patients with cancer-associated acute pulmonary thromboembolism and non-cancer-related acute pulmonary thromboembolism in China Institute of Respiratory Diseases, China Medical University undergoing sequential anticoagulation. 168 patients The clinical features and outcome of 60-day follow-up. Results The proportion of lung cancer was the highest among cancer patients (24.5%), followed by that of colon cancer (20.8%). There was no significant difference in age, gender, body weight, proportion of smokers, underlying diseases and severity between the two groups. Patients with cancer-associated acute pulmonary thromboembolism had more severe hypoxemia (P = 0.006) after 60 days of sequential anticoagulation and a significantly higher rate of re-embolization and mortality compared with non-cancerous patients (20.8% vs 4.2%, 26.4% vs 5.4%, all P <0.001). The incidence of thrombocytopenia and hemorrhage was also higher in non-cancer groups (22.6% versus 13.7%, 24.5% vs. 8.9%, respectively; P = 0.119 and 0.003). There was a statistically significant difference in bleeding rates between the two groups. Conclusions Sequential anticoagulant therapy with warfarin predominates in patients with cancer-related acute pulmonary thromboembolism, with poor response, more adverse reactions, high mortality and poor prognosis. Such patients may require new anticoagulation regimens such as LMWH long-range anticoagulation.