晚期非小细胞肺癌患者凝血指标的临床分析

Clinical Analysis on Coagulation Markers in Advanced NSCLC Patients

目的探讨晚期非小细胞肺癌(NSCLC)患者凝血指标分布特点及与患者预后、中医证型和远期血栓性事件的相关性。方法选取住院治疗的NSCLC患者进行回顾性调查,对其凝血指标应用SPSS13.0软件进行数据分析。结果非晚期组患者出现1项和1项以上凝血指标异常的分别有10例(38.5%)和8例(30.8%),而晚期组NSCLC患者分别为95例(71.4%)和77例(57.9%),组间差异有统计学意义(P<0.05);血浆纤维蛋白原(FIB)、D-二聚体(D-dimer)的水平在晚期组和非晚期组患者中有显著差别。凝血指标中FIB和D-dimer的数值与晚期NSCLC患者的生存期成负相关(P<0.05)。FIB水平和气虚证关系密切(P<0.05)。血瘀证、气滞证与血凝状态关系密切,但只有前者有统计学意义(P<0.05)。晚期组血栓性不良事件发生率较非晚期组为高。结论晚期NSCLC患者普遍存在凝血功能异常,并且与不良预后密切相关,初步提示益气活血法可以作为中医药对凝血功能异常状态进行有效干预的方向之一。

Objective To discuss the distribution of coagulation markers in patients with advanced non-small cell lung cancer （NSCLC） and the correlation of these markers with the prognosis of the patients, the TCM syndrome and the long-term thrombotic events. Method Hospitalized NSCLC patients were selected for retrospective investigation and the coagulation markers data were analyzed with SPSS13.0. Result There were 10 cases （38.5%） and eight cases （30.8%） with one or more abnormal coagulation markers in the non-advanced NSCLC group, while there were 95 cases （71.4%） and 77 cases （57.9%） in the advanced NSCLC group. There were significant difference between the two groups （P〈0.05）. FIB and D-dimer levels showed significant difference between the advanced NSCLC group and the non-advanced NSCLC group as well. There was negative correlation between the values of FIB and D-dimer with the survival period of advanced NSCLC patients （P〈0.05）. FIB level was closely related to the qi deficiency syndrome （P 〈 0.05）. Blood stasis syndrome and gas stagnation syndrome were closely related to prothrombotic state, but only the former showed significant difference statistically （P 〈0.05）. The incidence of adverse thrombotic events was higher in the advanced NSCLC group than in the non-advanced NSCLC group. Conclusion Coagulation disorder is common among advanced NSCLC patients, which is closely related to poor prognosis. It is indicated that the method of benefiting vital energy and promoting blood can be used as one of effective TCM interventions in the treatment of coagulation disorder.