| [Objective] : Essential thrombocythemia (Essential Thrombocythemia ET)Philadelphia (PH) is a classic myeloproliferative neoplasm chromosome negative(Myeloproliferative disorders, MPD) subtypes in common. Through the analysis and summary of previous clinical cases, explore the international thrombosis prediction model (International Prognostic Score of Thrombosis for Essential Thrombocythemia IPSET) in our hospital with primary thrombocytosis in patients with application value,and to forecast future primary thrombocytosis in patients with thrombosis, the treatment effect for more basis.[method]: From March 2010 to March 2017 in 102 cases of ET patients who were diagnosed with treatment (select patients follow the guidelines given hydroxyurea or interferon and low-dose aspirin for standard treatment, increased familial platelet or family history of ET were not included in the scope of the study), according to the latest WHO standard again the definition and unification of data to analyze and evaluate. The factors that may lead to thrombosis in patients with ET were analyzed,including gene mutation, clinical symptoms, signs, age and sex. All patients were followed up until March 2017, and the overall survival rate (Overall Survival, OS),relative mortality (Related Mortality, RM), incidence of thrombosis, incidence of cardiovascular disease and mortality were observed during follow-up. Using Cox regression model (Cox s proportional hazards regression model ") were independent risk factors for patients with thrombosis, and C statistical test performance evaluation model, product limit method (Kaplan-Meier curve) and draw the survival curves of different groups. The results were compared with the international thrombus prediction model to find out the similarities and differences, and to discuss the feasibility of applying this model to evaluate the prognosis of patients with primary thrombocytosis in our province.[results]: The ET patients in Yunnan Province with thrombosis (prediction curve in our province patients were grouped as experimental model (IPSET model) is roughly in line with the international group for international IPSET model as the control model), independent risk factors of ET patients in our hospital thrombosis with IPSET integration: in the 102 cases of eligible patients, 44 were male. 58 women, among which 60 cases were detected the JAK2V617F mutation, 42 cases of negative patients.Multivariate COX regression analysis showed that the JAK2V617F mutation(HR=1.791), the age of risk than >60 years old [hazard ratio HR=1.818], previous history of thrombosis (HR=2.500), and cardiovascular risk factors (HR=1.712) was the independent risk factor of thromboembolic complications, and the international IPSET- thrombosis model. The COX model in the above risk factors C statistical value of 0.693 (95%CI:0.641-0.818), higher than that of the traditional hierarchical model of C value [0.624 (95% CI: 0.577-0.717), in the follow-up of 18 cases (11.7)thrombosis complications. Using IPSET in our hospital were divided into low risk group of 34 cases (0.33),30 cases of low risk group (0.29),10 cases of risk group(0.10),28 cases of high-risk group (0.27),there was statistical significance of thrombus free survival between the four groups (P<0.001). In the evaluation, 4 low-risk patients were divided into the lower risk group than the control group, and the middle risk group was divided into the high risk group and the high risk group.The patients were divided into 6 low-risk patients in the high-risk group. At the same time, vascular risk factors (Cardiovascular risk, factors, CVF) on the incidence of thrombosis effect re definition: in the control CVF patients with thrombosis was significantly higher than that of patients without CVF model of low risk group,medium risk group and the incidence of thrombosis. Therefore, the patients in the low risk group with CVF were divided into the middle risk group.[Conclusion]1. The prediction model of thrombosis in patients with ET in our hospital is consistent with the international IPSET prediction model.2. On the basis of the original IPSET model, through the analysis of the data, some patients with thrombosis in our hospital were divided into the group of thrombosis risk, and ET patients with low risk group were divided into CVF group.3.In our hospital patients with ET data integration model for the future of thrombosis visits in patients with ET incidence of thrombosis assessment, can effectively predict the incidence of thrombosis and approximate time, and active treatment of complications and symptoms. Some patients were divided into three groups, to avoid excessive or inadequate treatment of some patients, and more patients with thrombosis. It provides a lot of data basis for the future treatment and medication. |
