| Objective: To analyze the survival status of patients with myeloproliferative neoplasm(MPN),and to explore the correlation between thromboelastogram(TEG)and routine coagulation related indicators,and the application value of TEG in evaluating coagulation status of the patients with myeloproliferative neoplasm.Methods: 1.152 patients with myeloproliferative neoplasms from February 2012 to February 2019 in the First Affiliated Hospital of Jinan University were selected.Their clinical features were collected and summarized.Their survival status indicators such as clinical symptoms,MPN-10 score scale,complications,disease progression and transformation,death and survival time were analyzed.Kaplan-Meier was performed by SPSS 23.0 software.2.32 patients with myeloproliferative neoplasms from February 2018 to February2019 in the First Affiliated Hospital of Jinan University,and 31 patients with acute cerebral infarction and 10 patients with acute myocardial during the same period were selected.Their clinical features,TEG,routine coagulation tests and platelet were collected and analyzed using SPSS 23.0 software.P-value of <0.05 was considered to be statistically.Results : 1.Survival status analysis:(1)General characteristics: A total of 152 cases of MPN were collected,including 122 cases of BCR-ABL-negative MPN(61 cases of ET,31 cases of PV,30 cases of PMF),with a median age of 60.50 years,and 30 cases of BCR-ABL-positive chronic myeloid leukemia(CML),with a median age of 46.50 years.(2)Clinical symptoms: Dizziness and fatigue were the most common symptoms.The MPN-10 scale was completed in 65 patients with MPN.The fatiguegot the highest score with(3.06 ± 2.13)points.The total scores of three subtypes from high to low were(14.64± 7.68)points(PMF),(12.59±14.90)points(ET),(11.88 ± 7.86)points(PV).44.08% of patients had spleen enlargements.(3)Infectious diseases: 28.69% of patients had infectious diseases,78.26% of which occurred in the respiratory system.(4)Cardiovascular diseases:40.13% of patients had hypertension or(and)diabetes.(5)Thrombotic diseases:28.95% of patients had thrombotic events,63.64% of which were cerebral infarction.51.61% of patients with PV,39.34% of patients with ET,10.00% of patients with PMF,and 3.33% of CML patients had thrombosis events.(6)Bleeding diseases:11.18% of patients had bleeding events,33.33% of which occurred in digestive tract.23.33% of patients with CML,14.75% of patients with ET,3.33% of patients with PMF and 3.23%of patients with PV had bleeding events.(7)Progression and transformation: 4.10% of patients with BCR-ABL-negative MPN transforted into myelofibrosis,1.6% of them transforted to AML,and 16.67% of patients with CML to ALL or AML.(8)Death cases: 20/152 cases(13.16%)patients died.15/20 cases patients with BCR-ABL negative MPN patients died with a median age of 73 years old,46.67% of whom died of severe coagulation diseases.5/20 cases patients with CML died with a median age of 53 years,80% of whom died of chemotherapy complications.(9)Survival time:The average survival time of patients with BCR-ABL-negative MPN was significantly longer than that of patients with BCR-ABL-positive CML(18.47 ± 2.17 years vs 10.70 ± 1.28 years).The survival time patients with PV was the longest(21.01±4.53 years).2.Correlation between TEG and routine coagulation tests and the significance of TEG in MPN:(1)Correlation between TEG and routine coagulation tests: α and MA were positively correlated with FIB and PLT(P <0.01);K value was negatively correlated with FIB and PLT(P <0.01).(2)There is correlation between each parameter of TEG: α and MA value were negatively correlated with K and R(P<0.05).α was positively correlated with MA(P <0.01).K was positively correlated with R(P <0.01).(3)There were no significant differences in TEG parameters between 23 patients with BCR-ABL-negative MPN(ET,PV)and 9 patients with BCR-ABL-positive MPN(CML)(P>0.05).(4)Comparing TEG between three subtypes(ET,PV,CML),ET group had larger α and smaller K than PV group(P<0.05),suggesting ET group had high fibrinogen activity and high platelet count and quality level.(5)There were significant differences in TEG parameters(α,R,K,MA)among thrombus group,non-thrombosis group,acute cerebral infarction group and acute myocardial infarction group(P<0.05).Compared with non-thrombosis group,α and MA of the thrombus group were larger(P<0.05),α and MA of the cerebral infarction group were larger,R and K of the cerebral infarction group were smaller(P< 0.05),the MA of the myocardial infarction group was larger,and the R and K of the myocardial infarction group were smaller(P<0.05).That showed thrombus group,the cerebral infarction group,and the myocardial infarction group were in a more hypercoagulable state than the non-thrombosis group.There was no difference in TEG parameters among the thrombus group,cerebral infarction group and myocardial infarction group(P<0.05).Conclusions:1.Patients with BCR-ABL-negative MPN were middle-aged and elderly people with a median age of 60.50 years old,the average survival time of whom was18.47±2.17 years.65% of patients had dizziness and fatigue,which were the most common symptoms.There were high incidence of thrombotic and bleeding events(34.43% and 9.02% respectively).thrombotic disease,progression and transformation suggested a poor prognosis.Among three subtypes,patients with PV had the highest incidence of thrombosis and the longest survival time,and patients with PMF had the most obvious symptom burden,and patients with ET had the highest incidence of bleeding disease.2.Compared with BCR-ABL-negative MPN,CML patients were younger with a median age 46.50 years old and had a shorter survival time,the average of which was10.70 ± 1.28 years.The CML patients had higher incidence(23.33%)of bleeding diseases and lower incidence(3.33%)of thrombosis diseases.3.Thromboelastograms(TEG)were associated with routine coagulation indicators.The results of thromboelastography showed that there was no difference between BCR-ABL(-)MPN and BCR-ABL(+)MPN;ET group was hypercoagulable compared with PV group;compared with non-thrombotic group,thrombus group,the cerebral infarction group and the myocardial infarction group were in a hypercoagulable state,but there was no difference among the thrombus group,the cerebral infarction group and the myocardial infarction group. |
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