Analysis Of Thrombosis Risk Factors In Patients With Philadelphia Chromosome Negative Myeloproliferative Neoplasms

Purpose:Philadelphia chromosome-negative myelopro1iferative neoplasms(ph~-MPN)include polycythemia vera(PV),essential thrombocythemia(ET)and primary myelofibrosis(PMF).Bleeding and thrombosis are common complications of ph~-MPN,and are the main causes of disability,death and increased medical costs in ph~-MPN patients.Although it is known that ph~-MPN has a tendency to hemorrhage and thrombosis,the pathological mechanism behind it is unclear and may be affected by many factors.In order to further explore the risk factors of thrombotic events in ph~-MPN patients,we analyzed the relevant clinical indicators of ph~-MPN patients in our hospital,and obtained some clinical indicators that can be used to predict thrombosis in the study.Additionally,we aim to establish a predictive model of thrombosis to provide help for clinical treatment and diagnosis.Methods:We retrospectively analyzed the clinical data of 176 patients with confirmed ph~-MPN of our hospital from December 1,2009 to December 30,2020,to determine whether there is thrombosis during the initial diagnosis and follow-up of ph~-MPN.Patients were divided into thrombosis group and non-thrombosis group.We used SPSS25.0 statistical software to compare the two groups in age,sex,whether they have hypertension,diabetes,hyperlipidemia,smoking history,whether there is splenomegaly,past thrombosis,myeloproliferative neoplasms subtype,Blood count at the first visit and The difference between the reduced cell treatment plan,etc.,through single factor and multi-factor Logistic regression analysis to obtain the relevant factors of hemorrhage thrombosis,and establish a predictive model.Results:1.A total of 176 ph~-MPN patients were included in this study.The deadline for follow-up is December 30,2020.The median follow-up time was 16 months(1 month to 130 months).The median age of onset was 59(25-88)years old,with 96 males and80 females.During the follow-up period,a total of 55 patients had one or more thrombotic events,38 patients had thrombotic events at baseline,and 23 patients had thrombotic events during the follow-up period.2.Univariate analysis showed that age≥57.5 years old,history of hypertension,JAK2 V617F positive and thrombosis history are the promoting factors of thrombosis in ph~-MPN patients,and CALR gene mutation is the hindering factor of ph~-MPN thrombosis.3.Multiple logistic regression analysis manifested that JAK2 V617F gene mutation(OR=3.400,95%CI 1.053-10.980),history of thrombosis(OR=4.776,95%CI 1.363-16.743),age≥57.5 years(OR=2.211,95%CI 1.051-4.651)is an independent risk factor for thrombotic events in ph~-MPN.4.According to the principle of binary logistic regression,the regression equation of thrombosis in ph~-MPN patients is obtained:p=e~x/(1+e~x),x=-2.408+1.224×JAK2V617F gene mutation(Positive value is 1,negative value is 0)+1.564×past thrombosis history(with 1,and no 0)+0.793×age(≥57.5 years is 1,and<57.5 years is0).The optimal threshold of the model is x=-1.014,the sensitivity corresponding to the Youden index is 69.1%,and the specificity is 67.8%,indicating that the predictive value of the model is general.Conclusion:1.The incidence of thrombosis/thromboembolism in ph~-MPN patients is higher.21.59%of the patients in the study presented to the doctor due to thromboembolic events.2.JAK2 V617F gene mutation,past thrombosis history,age≥57.5 years old and hypertension are positively related to thrombosis,and CALR gene mutation is negatively related to thrombosis.3.JAK2 V617F gene mutation,a history of thrombosis,age≥57.5 years old is an independent risk factor for ph~-MPN thrombosis;ph~-MPN patients with a history of thrombosis increased the risk of thrombosis by 4.776times.For JAK2 gene mutation positive ph~-MPN patients.the risk of thrombosis increased by 3.400 times.The risk of thrombosis in ph~-MPN patients aged≥57.5 years increased by 2.211 times.3.In the face of ph~-MPN patients who have just received treatment,the risk factors for thrombosis should be evaluated at the beginning of treatment to select appropriate anti-platelet and cell-reducing treatment methods.