凝血功能监测在胆囊癌病情评估及预后预测中的意义

Significance of coagulation monitoring in evaluation of the conditions and prognosis of the patients with gallbladder cancer

目的：探讨凝血功能监测在评估胆囊癌病情及预测预后中的意义。方法：选取择期行手术治疗的胆囊癌患者87例和住院治疗的胆囊炎患者50例,利用全自动凝血分析仪对所有研究对象术前血浆凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）和纤维蛋白原（Fib）进行检测,所有胆囊癌患者术后均进行随访。结果：胆囊癌患者PT、TT和Fib均大于对照组,而APTT则小于对照组,差异均有统计学意义（P〈0.05）;胆囊癌中低分化患者Fib水平高于高分化患者,Ⅲ-Ⅳ期患者Fib水平高于Ⅰ-Ⅱ期患者,发生淋巴结转移患者Fib水平高于未发生转移患者,差异均有统计学意义（P〈0.05）;胆囊癌患者中高Fib血症发生率49.4%,显著高于对照组的18.0%,差异有统计学意义（P〈0.05）。在不同分化程度、不同TNM分期、是否发生淋巴结转移及不同T分期胆囊癌患者中高Fib血症发生比例差异有统计学意义（P〈0.05）;ROC曲线分析显示,Fib水平预测淋巴结转移曲线下面积0.730（95%CI：0.611-0.848）,灵敏度65.4%,特异度77.0%;胆囊癌伴高Fib血症患者中位生存期9.8个月,显著低于胆囊癌Fib水平正常患者（15.6个月）,差异有统计学意义（P〈0.05）。结论：胆囊癌患者凝血功能指标异常;Fib水平与胆囊癌分化程度、TNM分期和发生淋巴结转移关系密切,术前对胆囊癌患者进行Fib监测可对病情进展及预后提供一定的辅助参考价值。

Objective： To investigate the significance of coagulation monitoring in evaluation of the conditions and prognosis of the patients with gallbladder cancer. Methods： 87 cases of patientswith gallbladder cancer undergoing elective surgery, and 50 cases of patients with cholecystitis were selected as control group. The serum levels of prothrombin time（PT）, thrombin time（TT）, activated partial thromboplastin time（APTT）and fibrinogen（Fib）were detected by using automatic coagulation analyzer before surgery. All gallbladder cancer patients were followed up after surgery. Results： The PT, TT and Fib of Gallbladder patients were higher than the control group, while the APTT was lower than the control group, the differences were statistically significant（P〈0.05）. The levels of Fib in gallbladder cancer patients with poorly differentiated was higher than the patients with well- differentiated, in Ⅲ-Ⅳ stage was higher than inⅠ-Ⅱ stage, and in patients with lymph node metastasis was higher than lymph node metastasis did not occur, the differences were statistically significant（P〈0.05）. The incidence of hyperfibrinogenemia in gallbladder cancer patients was 49.4%, which was significantly higher than 18.0% of the control group, the difference was statistically significant（P〈0.05）.The differences of incidences of hyperfibrinogenemia between varying degrees of differentiation, different TNM stage, whether lymph node metastasis occur, and different T stages were statistically significant（P〈0.05）. ROC curve analysis showed that Fib levels in predicting lymph node metastasis, the area under the curve was 0.730（95% CI： 0.611-0.848）, sensitivity was 65.4%, specificity was 77.0%. The median survival of gallbladder cancer with hyperfibrinogenemia was 9.8 months,which was significantly lower than the patients with normal Fib levels, the difference was statistically significant（P〈0.05）. Conclusion： The coagulation indexes in gallbladder cancer patients were abnormal. Fib levels were closely related with gallbladder cancer differentiation, TNM stage and lymph node metastasis. Monitoring the Fib levels of gallbladder cancer patients before surgery could provide supplementary reference for disease progression and prognosis.