胆囊癌患者凝血功能变化及其临床意义

Change of coagulation in patients with gallbladder cancer and its clinical significance

目的 探讨胆囊癌患者凝血功能变化与临床病理特征间的关系.方法 回顾2007年1月至2013年6月收治的64例胆囊癌患者（胆囊癌组）和60例胆囊炎患者（对照组）的血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fib）、凝血酶时间（TT）.比较胆囊癌患者凝血功能的变化及上述指标与胆囊癌患者预后的关系.结果 与对照组比较,胆囊癌组患者APTT明显缩短[（29.0±4.2）s,t=-4.265,P=0.000],PT[（11.5±1.4）s]、TT[（15.3±3.5）s]延长（t=2.521、4.147,P＜0.05）、Fib明显升高[（4.1 ±0.9）g/L,t=4.365,P=0.000].中、低分化腺癌患者Fib高于高分化腺癌患者（F=4.069,P=0.022）,有淋巴结转移患者Fib明显高于无淋巴结转移者（t=2.640,P=0.010）,TNMⅡ～Ⅳ期患者Fib明显高于0～Ⅰ期患者（t=3.003,P＜0.01）.胆囊癌患者伴高纤维蛋白原血症比例（32/64）明显高于对照组（11/60,x2=13.709,P＜0.01）.且与胆囊癌Fib正常者相比,在肿瘤分化程度（x2=7.760）、浸润深度（x2=10.573）、淋巴结转移情况（x2=6.063）及病理分期（x2=5.851）差异均有统计学意义（P＜0.05）.胆囊癌伴高纤维蛋白原血症患者与胆囊癌Fib正常患者中位生存率分别为8.63个月和16.73个月,1、3年生存率分别为64.7％、14.9％和74.9％、21.1％,差异有统计学意义（P＜0.05）.结论 胆囊癌患者血清Fib水平在术前辅助评估疾病进展及预后等方面有一定的临床应用价值.

Objective To study the relationship between the change of coagulation and the clinicopathologic characteristics in patients with gallbladder cancer.Methods The 64 gallbladder cancer patients （GBC group） and 60 cholecystitis patients （control group） had been reviewed from January 2007 to June 2013.The prothrombin time （PT）,activated partial thromboplastin time （APTT）,fibrinogen （Fib）,and thrombin time （TT） had been measured and compared between patients of GBC group and control group.The relationship of coagulation function and prognosis were analyzed.Results Compared with control group,APTT in GBC group （（29.0 ± 4.2） s） was significantly shortened （t =-4.265,P =0.000） and PT （（11.5 ± 1.4） s）,TT （（15.3 ± 3.5） s）,Fib （（4.1 ± 0.9） g/L） were significantly increased in GBC group （t =2.521,4.147 and 4.365,all P ＜ 0.05）.The level of Fib was higher in patients with medium or poor-differentiated tumor cells （F =4.069,P =0.022）,lymph metastasis （t =2.640,P =0.010） and advanced staging （Ⅱ-Ⅳ） （t =3.003,P ＜ 0.01） than those of well-differentiated,non-lymph metastasis and early staging （0-Ⅰ）.The ratio of gallbladder cancer with hyperfibrinogenemia （32/64） was significantly higher than control group （11/60,x2 =13.709,P ＜ 0.01）.In GBC group,compared with normal Fib patients,hyperfibrinogenemia patients showed significantly difference in clinicopathologic characteristics （x2 =5.851-10.573,P ＜ 0.05）.The average survival period of hyperfibrinogenemia patients and normal Fib patients were 8.63 months and 16.73 months.The 1-,3-year survival rate of patients with hyperfibrinogenemia were significantly lower than those with normal Fib （64.7％,14.9％ vs.74.9％,21.1％,P ＜ 0.05）.Conclusion Preoperative plasma level of Fib might be a new promising biomarker in patients with gallbladder cancer for evaluating disease progression and prognosis.