Risk Factors For Occurrence Of Thrombosis In Philadelphia Chromosome-negative Myeloproliferative Neoplasms

ObjectiveThis paper retrospectively analyzed the clinical features of 58 patients with Philadelphia chromosome-negative myeloproliferative neoplasms(Ph~-MPN),which included 21 patients with polycythemia vera(PV),34 patients with essential thrombocytosis(ET),3 patients with primary myelofibrosis(PMF),so as to investigate the correlation among thrombosis in patients with Ph~-MPN and types of Ph~-MPN driver gene mutation,4G/5G polymorphism of plasminogen activator inhibitor-1(PAI-1)as well as infection.MethodPatients with Ph~-MPN seeking medical service from January 1st,2018 to December 31st,2018 in the Second Affiliated Hospital of Fujian Medical University were selected.Specific polymerase chain reaction(PCR)was used to detect the driver gene mutation.4G/5G polymorphism of PAI-1 was detected by sequencing reaction reagent kit.In addition,the influencing factors of thrombosis were analyzed byχ2statistical test,after which there was an comparison and analysis.What’s more,independent risk factors for thrombosis were studied by binary Logistic regression.Results1.(1)There were 51 patients with driver gene mutation,and the mutation rate was 88%(51/58).The mutation rate of JAK2 was 76%(44/58).All were JAK2V617F mutation.The mutation rate of CALR was 12%(7/58).The mutation rate of MPL gene was 0%(0/58).The triple negative patients accounted for 12%(7/58).(2)In terms of the patients with PV,the mutation rate of JAK2 V617F was 77%(16/21).The mutation rate of CALR was 0%(0/21).(3)As for the patients with ET,the mutation rate of JAK2 V617F was 79%(27/34).The mutation rate of CALR was 15%(5/34).2.(1)Among the patients with PV,the occurrence rate of thrombosis in patients with positive mutation of JAK2 V617F was higher than that in those with negative mutation of JAK2 V617F.But the difference was not statistically significant.(2)In terms of the patients with ET,the occurrence rate of thrombosis in patients with positive mutation of JAK2 V617F was higher than in those with negative mutation of JAK2 V617F.But the difference was not statistically significant.Besides,the occurrence rate of thrombosis in patients with positive mutation of JAK2 V617F was lower than that in those with positive mutation of CALR.However,the difference was statistically insignificant.3.(1)In the patients with PV,the occurrence rate of thrombosis in different types of gene arranged as 4G4G>5G5G>4G5G,but the differences were not statistically significant.(2)As for the patients with ET,the occurrence rate of thrombosis in different types of gene arranged as 4G4G>4G5G>5G5G,with statistically significant differences(P=0.04<0.05).4.For patients with ET and PV,the occurrence rate in patients with infection was higher than in those without infection,and the differences were statistically significant(P<0.05).5.(1)For the patients with PV patients,the occurrence rate of infection in different types of gene arranged as 4G4G>5G5G>4G5G,but the differences were not statistically significant.(2)As for the patients with ET,the occurrence rate of infection in different types of gene arranged as 4G5G>4G4G>5G5G,but the differences were not statistically significant.6.(1)In the patients with PV,the frequency of each gene type of PAI-1 in patients with positive mutation of JAK2 V617F arranged as 4G5G>4G4G>5G5G.Compared with patients with negative mutation of JAK2 V617F,the differences were not statistically significant.(2)As for the patients with ET,the frequency of each gene type of PAI-1 in patients with positive mutation of JAK2 V617F arranged as 4G4G>4G5G>5G5G.Compared with patients with negative mutation of JAK2 V617F,the differences were not statistically significant.However,when compared with those with positive mutation of CALR,the differences were statistically significant(P=0.04<0.05).7.According to the binary Logistic regression analysis,the gene type of 4G4G of PAI-1 and infection were related with the occurrence of thrombosis(P=0.00<0.05).OR values were 6.744(95%CI:1.195~38.056)and 15.641(95%CI:3.327~73.522),respectively.Conclusions1.In terms of the patients with ET,the occurrence rate of thrombosis in patients with the gene type of 4G4G of PAI-1 was higher than in those with the gene types of4G5G and 5G5G.Besides,the occurrence rate of thrombosis in patients with the gene type of 4G5G was higher than in those with the gene type 5G5G.2.For the patients with Ph~-MPN,the occurrence rate of thrombosis in patients with infection was higher than in those without infection.3.Among the patients with ET,the expression rate of each gene type of PAI-1 in patients with positive mutation of JAK2 V617F arranged as 4G4G>4G5G>5G5G.4.Among the patients with Ph~-MPN,those with positive mutation of JAK2V617F and 4G4G of PAI-1 are considered to be at high risk of thrombosis.With concurrent infection,the occurrence rate of thrombosis will increase in such patients.Under such circumstance,special attention should be paid to the prevention and control of thrombosis.