结直肠癌患者手术前后凝血纤溶指标的变化及意义

Changes and significance of coagulation and fibrinolysis indicators in pre-and post-operational patients with colorectal cancer

目的研究结直肠癌患者术前、术后凝血与纤溶指标的变化及其意义。方法结直肠癌组30例,非癌对照组20例。取空腹外周静脉血,测定白细胞计数(WBC)、血小板计数(PLT)、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)、D-二聚体(D-D)、纤维蛋白溶酶原激活物抑制物1(PAI-1)、血浆凝血酶原片段1+2(F1+2)、蛋白C(PC)、肿瘤标记物癌胚抗原(CEA)、糖类抗原19-9(CA19-9)。结直肠癌组术后7天再予测定血浆D-D、PAI-1、F1+2、PC。采用SPSS13.0软件对这些不同时期的数据值进行统计学处理,分析手术前后结直肠癌患者凝血与纤溶指标的变化。结果 (1)结直肠癌组FIB、D-D、PAI-1、F1+2水平较对照组增加,差异有统计学意义(P<0.05或P<0.01),而PC水平明显低于正常组(P<0.01),APTT结直肠癌组较对照组显著缩短(P<0.05)。(2)结直肠癌组患者术后D-D水平明显高于术前及对照组(P<0.01),而PAI-1、F1+2水平显著低于术前(P<0.01)但仍高于对照组(P<0.01),而术后蛋白C水平明显高于术前但低于对照组(P<0.01)。(3)结直肠癌组手术前后PAI-1与F1+2水平两者存在显著的相关关系(r=0.985,P<0.01),F1+2与PC或PAI-1与蛋白C两者均无相关关系(P>0.05)。

Objective To study the changes and significance of coagulation and fibrinolysis indicators in pre-and post-operational patients with colorectal cancer.Methods Thirty patients with colorectal cancer required elective surgery were selected as the colorectal cancer group.Twenty patients with non-cancerous was the control group.Peripheral venous blood samples were taken to determine the level of white blood cell count（WBC）,platelet count（PLT）,prothrombin time（PT）,activated partial thromboplastin time（APTT）,fibrinogen（FIB）,D-dimer（D-D）,plasminplasminogen activator inhibitor-1（PAI-1）,prothrombin fragment 1＋2（F1＋2）,protein C（PC）,and tumor markers carcinoembryonic antigen（CEA）,carbohydrate antigen 19-9（CA19-9）.D-D、PAI-1、F1＋2、PC were determined again at 7days after surgery for the experimental group.The data in these different groups were analyzed statistically by SPSS13.0software,then the changes of coagulation and fibrinolysis indicators in pre-and post-operational patients with colorectal cancer were analyzed lastly.Results FIB,D-D,PAI-1,F1＋2levels in patients with colorectal cancer group were higher compared with the control group,and the difference was statistically significant（P〈0.05）.The PC level in patients of colorectal cancer group were significantly lower than the control group（P〈0.01）.The APTT of colorectal cancer group was shorter than the control group（P0.05）.The Postoperative D-D level of colorectal cancer group was significantly higher than preoperative or control group（P〈0.01）,while the PAI-1,F1＋2levels were lower than preoperative（P〈0.01）but still higher than the control group（P〈0.01）.Compared with PAI-1and F1＋2,PC just the opposite（P0.01）.Regardless of preoperative or postoperative,there is significant correlation between PAI-1and F1＋2levels in the colorectal cancer group（r=0.985,P〈0.01）,but there is no correlation between PAI-1and PC or between F1＋2and PC（P〉0.05）.Conclusion Colorectal cancer patients and patients with other malignancies as obvious abnormal coagulation and fibrinolysis,manifested as hypercoagulable states.And higher risk of thrombotic diseases,it should be given appropriate anticoagulant therapy.After radical surgery,the blood of patients with colorectal cancer remains hypercoagulable state,but mitigation compared with the preoperative.It prompted complications of thrombotic diseases may occur after operation such as pulmonary embolism,deep vein thrombosis.Closely observed,positive diagnosis and treatment should be required.PAI-1,F1＋2and PC levels in colorectal tumor patients were strongly associated to tumor size,and may be follow-up indicators.