凝血参数异常对胰腺癌诊治的临床意义

Clinical significance of coagulation parameters in patients with pancreatic cancer

目的检测胰腺癌患者凝血功能，研究胰腺癌患者的凝血功能紊乱状态，探讨其在肿瘤形成、进展和转移中的作用及其对胰腺癌临床诊治的参考价值。方法使用STAGOCompact全自动血凝分析仪及配套试剂检测114例经手术或穿刺病理确诊的胰腺癌初诊患者及40例健康体检者的9项凝血参数，收集、分析胰腺癌初诊患者的临床分期、病理分级等临床信息。结果与对照组凝血参数比较，胰腺癌组血浆抗凝血酶Ⅲ（AT-Ⅲ）、血浆蛋白c明显降低，而血浆凝血酶原时间、血浆活化部分凝血酶原时间、国际标准化比值、血浆纤维蛋白原、血浆凝血因子Ⅷ、D二聚体（D-D）明显升高；D-D随着临床分期的升高而升高，AT-Ⅲ则随着临床分期的升高而降低；D-D随着病理分级的变差而逐渐升高。结论胰腺癌患者存在高凝、抗凝功能降低和继发性纤溶亢进的凝血功能紊乱状态。血浆D-D与临床分期、病理分级和远处转移明显相关。其与AT-Ⅲ可以作为胰腺癌患者病情进展评估的监测指标。

Objective To investigate the coagulation disorder status of patients with pancreatic cancer and to explore its role in tumor formation, progression and metastasis. Method The present study involved 114 patients with pancreatic cancer diagnosed by surgery or biopsy, and 40 healthy vol- unteers. For each individual, nine plasma coagulation parameters were tested using the STAGO Com- pact automated. Results The levels of plasma antithrombinⅢ （AT-Ⅲ） and protein C of the pancreat- ic cancer group were significantly reduced compared with the control group, while the levels of plasma PT, APTT, INR, FIB, F-W, D-dimer （D-D） were significantly elevated. The level of plasma D-D increased with increase in clinical stage, while the level of AT-Ⅲ decreased. The level of plasma D-D became higher with worsening in histological grade. Conclusions Patients with pancreatic cancer were in a state of hypercoagulation, with reduced anticoagulation function and secondary hyperfibrinolysis. The level of Plasma D-D was significantly associated with the clinical stage, histological grade and dis- tant metastasis. These together with AT-Ⅲ could be used as indicators to monitor patients with pan- creatic cancer.