化疗对胃肠道肿瘤患者凝血功能的影响

The impact of chemotherapy on coagulation function in patients with gastrointestinal cancer

目的探讨化疗对胃肠道肿瘤患者凝血功能的影响。方法收集我院化疗科2009年1月至2012年5月治疗的胃肠道肿瘤患者181例，依照肿瘤是否发生转移分为远处转移组（68例）和无远处转移组（113例），另匹配健康体检者270名为对照组。观察肿瘤患者及正常对照的血浆凝血酶原时间（胛）、活化部分凝血活酶时间（APTT）、血浆纤维蛋白原（FIB）、总凝血酶时间（TT）、D-二聚体（D—D）浓度，并比较化疗前后胃肠道恶性肿瘤患者上述凝血指标的浓度。结果3组化疗前PT、APTT、FIB、TT、D—D差异均有统计学意义（F值分别为4．443、4．791、5．795、3．671、10．564，P均〈0．05），且肿瘤无远处转移组和肿瘤远处转移组PT[（11．31±0．98）s、（11．20±0．95）s与（11．99±0．89）s]、AVTT[（29．01±4．52）s、（28．25±3．98）s与（30．45±4．95）s]、TT[（19．35±2．09）s、（18．68±1．98）s与（19．98±1．89）s]均低于健康对照组，FIB[（3．05±0．68）g/L、（3．89±1．01）g/L与（2．29±0．38）g／L]、D—D[（98．88±15．94）μg／L、（227．31±35．12）μg／L与（35．41±3．43）μg／L]高于健康对照组（P均〈0．05）；肿瘤远处转移组在FIB[（3．89±1．01）g／L与（3．05±0．68）g／L]、D—D[（227．31±35．12）μg/L与（98．88±15．94）μg／L]亦高于肿瘤无远处转移组（P均〈0．05）。化疗前后对比发现，肿瘤远处转移组和无转移组化疗前后PT、APTT、D．D、TI？比较差异均无统计学意义（P均〉0．05），化疗后FIB较化疗前显著降低，差异均有统计学意义[转移组：（3．25±0．78）∥L与（3．89±1．01）g／L；无转移组：（2．58±0．75）g／L与（3．05±0．68）g/L；P均〈0．05）]。结论胃肠道肿瘤患者存在明显的高凝状态，随着转移灶的出现，高凝状态可加重；并且化疗可一过性增加血栓形成的风险。临床医师需要认清化疗前后肿瘤患者高凝状态的变化，从而为临床治疗提供帮助。

Objective To investigate the chemotherapy on coagulation function in patients with gastrointestinal cancer. Methods One hundred eight-one cases of gastrointestinal cancer patients who were taken chemotherapy in our hospital were collected from January 2009 to May 2012. According to tumor metastasis, they were divided into distant metastasis group （n = 68 ） and no distant metastasis group （n = 113 ）, and then 270 cases of healthy persons were matched as control group. Plasma prothrombin time （PT） , activated partial thromboplastin enzyme time （ APT＇F）, plasma fibrinogen （ FIB ） , the total thrombin time （ TF）, and D- dimer （DD） level were observed and compared between these groups. And the level of coagulation indicators in patients with gastrointestinal cancer was compared before and after chemotherapy. Results There were significant differences among three groups on levels of PT,APTT,FIB,TT and D-D （ F =4. 443,4. 791,5.795, 3.671,10. 564, respectively, P 〈 0. 05 ） before chemotherapy. The PT [ （ 11.31±0. 98 ） s and （ 11.20±0. 95 ） s vs （11.99±0.89）s] and APTT[ （29.01±4.52）s and （28.25 ±3.98）s vs （30.45±4.95）s] and TT [ （ 19. 35 ±2. 09） s and （ 18.68±1.98 ） s vs （ 19. 98±1.89 ） s ] in the tumor without distant metastasis and tumor distant metastasis groups were significantly lower than those in the healthy control group （ P 〈 0.05 ） , however FIB [ （3.05 ± 0. 68 ） g/L and （3.89±1.01 ） g/L vs （2. 29±0. 38 ）g/L] and D-D [ （98.88±15.94） μg/L and （227.31±35.12）μg/L vs （35.41±3.43 ） μg/L ] were significantly higher than those in the healthy control group （ P 〈 0.05 ） ; FIB [ （ 3.89±1.01 ） g/L vs （ 3.05±0. 68 ） g/L ], DD [ （227.31± 35.12 ） p,g/L vs （98.88±15.94） μg/L] in distant metastasis group were also significantly higher than those in no distant metastasis group （P 〈 0.05 ）. On comparison before and after chemotherapy, there was no significant difference on PT, AFFF, D-D and TT between distant metastasis group and no distant metastasis group （ P 〉 0. 05 ） , but FIB decreased significantly in two groups after chemotherapy [ Distant metastasis group ： （ 3.25 ± 0. 78 ） g/L vs （3.89 ± 1.01 ） g/L; No distant metastasis group： （ 2. 58±0. 75 ） g/L vs （ 3.05 ± 0.68 ） g/L; P 〈 0.05 ） ] . Conclusion The patients with gastrointestinal cancer are on the hypercoagulable state. In addition, hypercoagulable state could be increased with the emergence of metastases. Chemotherapy may be a transient increasing in the risk of thrombosis. Clinicians need to recognize the hypercoagulable state in cancer patients before and after chemotherapy, that will provide help for clinical treatments.