Analysis of clinical characteristics and coagulation status in patients with aspirin resistant polycythemia vera and essential thrombocythemia
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摘要: 目的：探讨阿司匹林抵抗的真性红细胞增多症（PV）和原发性血小板增多症（ET）患者的临床特点及凝血功能。方法：收集2019年6月—2021年4月于中国中医科学院西苑医院血液科门诊就诊的骨髓增殖性肿瘤患者63例（PV 21例，ET 42例），按照花生四烯酸抑制率，将患者分为阿司匹林抵抗（AR）组（43例）与阿司匹林敏感（AS）组（20例），对2组患者临床特征（性别、年龄、阿司匹林是否规律服用、合并症、基因突变、血细胞计数）和凝血功能进行分析。结果：63例患者AR发生率为68.3%（43/63），其中ET患者AR发生率显著高于PV患者（81.0% vs 42.9%，P<0.05）。与AS组比较，AR组女性、不规律口服阿司匹林、有驱动基因突变患者所占比例显著增多（P<0.05），血红蛋白与红细胞比容显著降低（P<0.05），血小板计数与血小板压积显著升高（P<0.05）。Logistic回归分析显示，女性患者（OR=5.657，95%CI 1.368~23.390）和有驱动基因突变的患者（OR=7.250，95%CI 1.420~37.028）发生AR的风险更高（P<0.05）。凝血状态方面，与AS组比较，AR组纤维蛋白降解产物显著降低（P<0.05），R值与K值显著缩短（P<0.05），α角、MA值及CI显著升高（P<0.05），其余指标差异无统计学意义。结论：ET患者AR发生率明显高于PV患者。女性和有驱动基因突变的患者发生AR的风险较高。与发生AS的PV和ET患者比较，发生AR的PV和ET患者处于相对高凝状态。Abstract: Objective: To explore the clinical characteristics and coagulation function of patients with aspirin-resistant polycythemia vera(PV) and essential thrombocythemia(ET).Methods: A total of 63 patients with myeloproliferative neoplasms from June 2019 to April 2021 in our hospital were collected, including 21 cases of PV and 42 cases of ET. According to the inhibition rate of arachidonic acid, patients were divided into aspirin resistance(AR) group(43 cases) and aspirin sensitive(AS) group(20 cases). The clinical characteristics(gender, age, whether aspirin was taken regularly, comorbidities, gene mutations, blood cell count) and coagulation function of patients in the two groups were analyzed.Results: The incidence of AR in 63 patients was 68.3%(43/63). The incidence of AR in patients with ET was significantly higher than that in patients with PV(81.0% vs 42.9%, P<0.05). Compared with the AS group, the proportion of women, irregular oral aspirin, and driver gene mutations in the AR group was significantly increased(P<0.05), hemoglobin and hematocrit were significantly reduced(P<0.05), and the platelet count and platelet crit were significantly increased(P<0.05). Logistic regression analysis showed that female patients(OR=5.657, 95%CI 1.368-23.390) and patients with driver gene mutations(OR=7.250, 95%CI 1.420-37.028) had a higher risk of AR(P<0.05). In terms of coagulation status, compared with the AS group, fibrinogen degradation product in AR group was significantly reduced(P<0.05), and R value was significantly decreased, K value was significantly shortened(P<0.05), α angle, MA value and CI were significantly increased(P<0.05). There was no significant difference in other indicators.Conclusion: The incidence of AR in ET patients is significantly higher than that in PV patients. Women and patients with driver gene mutations have a higher risk of AR. Compared with PV and ET patients with AS, PV and ET patients with AR are in a relatively hypercoagulable state.
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