老年肺癌患者首次化疗前凝血指标与肿瘤临床病理特征的关系

Relationship between coagulation parameters and clinical pathological characteristics in elderly patients with lung cancer before chemotherapy for the first time

目的:探讨老年肺癌患者首次化疗前的凝血指标与肿瘤临床病理特征的关系。方法:检测89例首次化疗前的老年肺癌患者(肺癌组)和30例健康者(对照组)的凝血指标:纤维蛋白原(FIB)、部分活化凝血酶原时间(APTT)、凝血酶原时间(PT)、D-二聚体(D-D)、血小板计数(PLT)等,并结合患者的病理类型(鳞状细胞癌、腺癌、腺鳞癌、大细胞癌、小细胞癌及其他)、肿瘤分化程度(高分化、中分化和低分化)、TNM分期(0期、Ⅰ期、Ⅱ期、Ⅲ期及Ⅳ期)及淋巴结转移(N0、N1及N2)情况进行分析。结果:老年肺癌患者血浆FIB、D-D及PLT水平比健康对照组显著增加,APTT与PT水平比健康对照组显著减少(P<0.05);鳞状细胞癌及大细胞癌患者的FIB、APTT、PT、D-D优于腺鳞癌、腺癌与小细胞癌,差异有统计学意义(P<0.05);中、高肿瘤分化程度患者的FIB、APTT、PT、D-D均优于低分化程度的患者,差异有统计学意义(P<0.05);Ⅰ、Ⅱ期与Ⅲ、Ⅳ期之间FIB、APTT、PT、D-D及PLT差异有统计学意义(P<0.05),Ⅰ、Ⅱ期优于Ⅲ、Ⅳ期;N0、N1、N2期两两之间FIB、PT、APTT、D-D及PLT差异均有统计学意义(P<0.05);APTT、PT与淋巴结转移具有负相关性(P<0.05),FIB、D-D及PLT与淋巴结转移具有正相关性(P<0.05)。结论:老年肺癌患者凝血功能指标与肺癌的病理类型、恶性程度、临床分期及淋巴结转移有关系,凝血功能指标变化也可能是促进肿瘤细胞的生长及转移的信号;肺癌患者极易发生血栓。

Objective. To explore the relationship between coagulation parameters and clinical pathological characteristics in elderly patients with lung cancer before chemotherapy for the first time. Methods： Levels of coagulation parameters of 89 cases of elderly patients with lung cancer before chemo-therapy for the first time （ lung cancer group） and 30 healthy subjects （control group） were compared, in- cluding fibrinogen （FIB）, part of the activation of prothrombin time （APTT）, prothrombin time （PT）, D - dimer （D- D）and platelet count （PLT）. The relationship between coagulation parameters and pathologi- cal types （Squamous cell carcinoma, adenocarcinoma, squamous carcinoma, large cell carcinoma, small cell carcinoma and other）, the degree of tumor differentiation （poor-differentiated, moderately-differentia- ted and well-differentiated）, TNM staging （stage 0, stage Ⅰ , stage Ⅱ, stageⅢ and stage Ⅳ） and lymph node metastasis （N0, N1, and N2） were analyzed. Results. The levels of FIB, D-D and PLT in lung canc- er group were significantly elevated compared with healthy control group （P〈0.05）, the level of PT and APTT was significantly reduced （P〈0.05） than the healthy control group. FIB, D-D, PT and APTT in patients with squamous cell carcinoma and large cell carcinoma were better than those in patients with ade- nocarcinoma, squamous carcinoma and small cell carcinoma （P〈0.05）. FIB, D-D ,PT and APTT in pa- tients with moderately-differentiated and well-differentiated were better than those in patients with poor- differentiated（P（0.05）, FIB, D-D ,PT, APTT and PLT in patients in stageⅠ and stage Ⅱ were better than those in patients in stage Ⅲ and stage Ⅳ （P〈0.05）. There was significant difference between any lymph node metastasis （N0, N1, or N2） and the other （P〈0. 05） in levels of FIB, D-D, PT, APTT and PLT. APTT and PT had negative correlation with lymph node metastases （P〈0.05）, FIB, D-D and PLT had a positive correlation with lymph node metastasis （P〈0.05）. Conclusions. There is relationship be- tween coagulation parameters and clinical pathological characteristics in elderly patients with lung cancer. The changes of coagulation parameters may be the signal of the growth and metastasis of tumor cells, thrombosis easily happen in patients with lung cancer.