乳腺癌术后发生下肢深静脉血栓的危险因素及血栓风险评估

  目的   研究乳腺癌患者术后发生下肢深静脉血栓(deep venous thrombosis，DVT)的危险因素，分析血栓风险评估模型的临床价值。  方法  回顾性分析2013年1月至2016年6月天津医科大学肿瘤医院703例术后发生血栓的患者为血栓组，通过系统抽样法选取对照组706例，分析乳腺癌患者术后发生下肢DVT的危险因素，并比较Khorana及Caprini血栓风险评估模型的预测价值。  结果  比较血栓组与对照组的年龄、BMI≥30 kg/m2、手术切除活检确诊、接受新辅助化疗、手术时间>2 h、治疗前脂蛋白a(Lpa)>475.5 mg/L、血浆蛋白C(PC) < 102.5%、血浆凝血因子Ⅷ(FⅧ)>129.8%及D-二聚体(D-D)>289.99 ng/mL，差异具有统计学意义(P < 0.05)。两组患者的Khorana风险评估模型进行比较，差异无统计学意义(P = 0.207)；两组患者的Caprini风险评估模型进行比较，差异具有统计学意义(P < 0.001)。  结论   年龄、BMI≥30 kg/m2、手术切除活检确诊、接受新辅助化疗、手术时间>2 h、治疗前Lpa>475.5 mg/L、PC < 102.5%、FⅧ>129.8%及D-D>289.99 ng/mL是乳腺癌术后发生下肢DVT的独立危险因素，Caprini评估模型可能导致乳腺癌患者血栓风险评估偏高，应进一步探究更加适合乳腺癌患者血栓的风险评估模型。 

Risk factors of lower limb DVT and thrombosis risk assessment after breast cancer surgery

  Objective  To investigate the risk factors of breast cancer complicated with deep venous thrombosis (DVT) in lower limb and to explore the predictive significance of the thrombus risk assessment model for patients with breast cancer.  Methods  A total of 703 patients with breast cancer in Tianjin Medical University Cancer Institute and Hospital who suffered from DVT after operation during January 2013 to June 2016 were retrospectively selected as the thrombosis group. A total of 706 cases for the control group were selected by systematic sampling. The risk factors of lower limb DVT after surgery were investigated. The predictive values of the Khorana and Caprini thrombosis risk assessment models for these patients were also presented in this research.  Results  Age, BMI ≥30 kg/ m2, diagnosis by excisional biopsy, neoadjuvant chemotherapy, operation time >2 h, lipoprotein a (Lpa) >475.5 mg/L, protein C (PC) < 102.5%, blood coagulation factor-Ⅷ (F-Ⅷ) >129.8%, and D-Dimer (D-D) >289.99 ng/mL had statistical differences between in the two groups (P < 0.05). Significant difference between the groups was found in the Caprini scores (P < 0.001) but not in the Khorana thrombosis risk assessment model (P = 0.207).  Conclusion  Age, BMI ≥30 kg/m2, diagnosis by excisional biopsy, neoadjuvant chemotherapy, operation time >2 h, Lpa >475.5 mg/L, PC < 102.5%, F-Ⅷ >129.8%, and D-D >289.99 ng/mL are the independent risk factors of thrombosis. The Caprini thrombosis risk assessment model may require complicated evaluation. Hence, a new model that is suitable for patients with breast cancer must be developed.