摘要目的 评估修订版国际血栓预测模型(IPSET)在中国原发性血小板增多症(ET)患者中的应用价值,探索适用于中国ET患者的血栓预测模型.方法 对1982年3月1日至2012年4月30日期间诊治的746例成人ET患者的病历资料进行回顾性分析.结果 全部746例患者中,男305例,女441例,诊断时中位年龄52(18～87)岁.采用修订版IPSET将患者分组,其中极低危组271例(36.3％)、低危组223例(29.9％)、中危组63例(8.4％)、高危组189例(25.3％),四组的无血栓生存差异有统计学意义(χ2=72.301,P＜0.001).修订版IPSET在原版IPSET低危组中区分出36例中危患者,在原版IPSET中危组中区分出19例高危患者,在原版IPSET高危组中区分出51例低危患者,避免了部分患者的治疗不足或过度.修订版IPSET低危组中有心血管危险因素(CVF)者的血栓发生率显著高于无CVF者[16.3％(8/49)对5.2％ (9/174),x2=5.264,P=0.022],而与中危组相当[16.3％(8/49)对14.3％ (9/63),x2-0.089,P=0.765].因此,在修订版IPSET的基础上,低危组中伴CVF者被划分至中危组,即为适于中国ET患者的修订版IPSET,此模型能区分出更多的血栓患者.结论 修订版IPSET在血栓预测方面优于原版IPSET,将修订版IPSET优化后得到了更适于中国ET患者的修订版IPSET,为中国ET患者的分层治疗提供了依据.

abstractsObjective To evaluate the role of the revised International Prognostic Score of Thrombosis (IPSET-thrombosis) in predicting the occurrence of thrombotic events in Chinese patients with essential thrombocythemia (ET) and to develop a thrombosis predicting model more applicable to Chinese ET patients.Methods Medical records of 746 adult patients with an initial diagnosis of ET were retrospectively analyzed.Results The median age at diagnosis was 52(18-87) years,with 305 males and 441 females.According to the revised IPSET-thrombosis model,the number of very low-,low-,intermediate-,and high-risk patients were 271 (36.3％),223 (29.9％),63 (8.4％) and 189 (25.3％),respectively.The four groups exhibited significantly different thrombosis-free survival (x2=72.301,P＜ 0.001).Thirty-six patients were reclassified as intermediate-risk according to the revised IPSET-thrombosis instead of low-risk as per the original IPSET-thrombosis.Nineteen intermediate-risk patients as per the original IPSET-thrombosis were upgraded to high-risk according to the revised IPSET-thrombosis.Fiftyone high-risk patients as per the original IPSET-thrombosis were reclassified as low-risk in the revised IPSET-thrombosis.It suggests that the revised IPSET-thrombosis potentially avoids over-or undertreatment.In low-risk patients as per the revised IPSET-thrombosis,the rate of thrombosis in patients with cardiovascular risk factors (CVF) was higher than that in those without (16.3％ vs 5.2％,χ2=5.264,P=0.022),and comparable with intermediate-risk patients as per the revised IPSET-thrombosis (16.3％ vs 14.3％,χ2=0.089,P=0.765).As a result,a new revised IPSET-thrombosis model more applicable to Chinese ET patients was developed in which patients with CVF in the low-risk group as per the revised IPSET-thrombosis were reclassified as intermediate-risk group.Conclusion For predicting the occurrence of thrombotic events,the revised IPSET-thrombosis model was better than the original IPSET-thrombosis model.The revised IPSET-thrombosis was optimized and a new revised IPSET-thrombosis model more applicable to Chinese ET patients was developed,and the new evidence for risk stratification and treatment of ET in Chinese was provided.