血细胞计数和D-二聚体检测在肺癌并发血栓患者中的变化研究

Analysis of the Changes of Blood Cell Count and D-dimer in Lung Cancer Patients with Thrombosis

目的：探讨肺癌并发血栓患者的血细胞计数和D-二聚体的变化及其对肺癌患者并发血栓的诊断作用。方法①选取2012年1月-2013年11月间554例肺癌患者，排除75例其他导致高凝状态疾病的患者，对64例病例组肺癌并发血栓患者与415例对照组肺癌未并发血栓患者的血细胞计数和D-二聚体进行比较。②以血管彩超作为诊断血栓的金标准，对方法1中t检验有统计学意义的指标绘制受试者工作特性曲线（receiver operating characteristic curve，ROC曲线）。结果①肺癌并发血栓患者红细胞计数（red blood cell count，RBC）显著降低、白细胞计数（white blood cell count，WBC）显著增高、D-二聚体含量显著增高、而血小板计数（platelet cell count，PLT）无明显变化。②RBC的 ROC曲线下面积（area un-der the curve，AUC）为0.662，Kappa＝0.128；WBC的ROC AUC＝0.637，Kappa＝0.110；D-二聚体的ROC AUC＝0.896， Kappa＝0.668。以 RBC＞4.06×10^12／L，WBC＜5.37×10^9／L，D-二聚体＜4.02 mg／L对肺癌患者是否并发血栓的阴性预测值分别为93％，93％，96％；以D-二聚体＞4.02 mg／L诊断肿瘤患者是否并发血栓阳性预测值为66％。结论对 RBC， WBC和D二聚体的测定可以反应肺癌患者血栓的发生发展；RBC，WBC和 D-二聚体对肺癌患者是否并发血栓有很好的阴性预测作用；D-二聚体对肿瘤患者是否并发血栓有一定的阳性预测作用。

Objective To analyze the changes of Blood Cell Count and D-dimer concentration in lung cancer patients with thrombosis.Methods ①554 cases of patients with lung cancer were included between January 2012 and November 2013,75 patients with other diseases which lead to high coagulation state were excluded,blood cell count and D-dimer concentration were compared between 64 lung cancer patients were the cases with thrombosis with 415 lung cancer patients were the control group without thrombosis.②Color doppler ultrasonography was taken as the golden standard,receiver operating characteristic curves （ROC）were drawn for indexes which had significance in method.Results ①Compared with lung cancer patients without thrombosis,lung cancer patients without thrombosis had decreased red blood cell count （RBC）,increased white blood cell count （WBC）and D-dimer.And there were no significant change in platelet （PLT）.②The area under curve （AUC）of ROC in RBC,WBC and D-dimer were 0.662,0.637 and 0.896,respectively.By thecut-off values of RBC〉4.06× 10^12 L,WBC〈5.37×10^9/L and D-dimer〈4.02 mg/L,the negative predictive values of RBC,WBC and D-dimer for diagnosis of lung cancer patient with thrombosis were 93%,93% and 96%,respectively.By the cut-off value of D-dimer〉4.02 mg/L,the positive predictive value of D-dimer for diagnosis of lung cancer patient with thrombosis was 6 6%.Conclusion RBC,WBC and D-dimer were related with the progress of thrombosis in lung cancer patients.RBC,WBC and D-dimer have good negative prediction effect on lung cancer patients with thrombosis.D-dimer had positive effect for diagnosis of lung cancer with thrombosis.