血浆组织因子途径抑制物-1在肺癌诊疗中的应用价值

Applied Significance of Plasma Tissue Factor Pathway Inhibitor-1 in the Diagnosis and Treatment of Lung Cancer Patients

目的探讨血浆组织因子途径抑制物-1（TFPI-1）在肺癌鉴别诊断、病情及疗效判断中的应用价值。方法测定68例非小细胞肺癌（NSCLC）和32例良性肺疾病患者以及40名体检健康者血浆TFPI-1、抗凝血酶（AT）和D-二聚体（D—D）水平，分析三者的相关性；观察治疗前后TFPI-1与其余二者水平的变化，运用ROC曲线分析TFPI-1在肺癌鉴别诊断、并发DVT以及肺癌转移中的诊断效能。结果肺癌组TFPI-1和AT水平显著低于而D—D水平显著高于疾病对照组和正常对照组（P〈0．001）；TFPI-1水平与AT呈高度正相关，与D～D呈高度负相关（r=0．789和-0．822，P=0．000）。并发DVT组和有转移组TFPI-1水平均分别显著低于无DVT组和无转移组（P=0．000）。TFPI-1鉴别诊断肺癌、预测并发DVT和肺癌转移的界值分别为52．3、58．2和64．3ng／ml，其ROC曲线下面积分别为0．884（95％CI：0．811—0．958）、0，957（95％CI：0．919～0．996）和0．856（95％CI：0．774—0．938）（P〈0．05），敏感度分别为86．76％、89．5％和82．1％，特异性分别为83．33％、85．5％和82．5％。与治疗前比较，治疗后TFPI-1、AT水平显著升高，D—D水平显著降低（P〈0．001），而动态观察的4例肺癌患者在治疗初期TF．PI-1水平总体呈持续升高趋势，AT和D—D则在至少6天后开始升高或降低。结论血浆TFPI-1测定在肺癌鉴别诊断、患者病情判断以及疗效观察中都具有重要意义。

Objective To explore the applied significance of plasma tissue factor pathway inhibitor - 1 （TFPI - 1 ） in differential di- agnosis, disease conditions evaluation, and therapeutic observation of lung cancer patients. Methods Plasma levels of TFPI - 1, an- tithrombin （AT） , and D -dimer （D -D） were measured in 68 non -small cell lung cancer （NSCLC） patients, 32 benign lung disease patients, and 40 healthy individuals, and the correlation was analyzed between the levels of TFPI - 1 and AT, as well as D - D. The alter- nation of the three indicators was observed before and after treatment. Receiver operating characteristic （ROC） curve was used to analyze their diagnostic efficiency in differential diagnosis, prediction of deep venous thrombosis （DVT） and metastatic spread of NSCLC. Results In NSCLC group, levels of TFPI - 1 and AT were significantly lower, D - D level was markedly higher, than those in disease control group and healthy control group （P = 0. 000） . There was positive and negative correlation between levels of TFPI - 1 and AT as well as D - D, respectively （r = 0. 789 and - 0. 822, P 〈 0.01 ）. In DVT group and metastatic spread group, TFPI - 1 levels were significantly lower than those in non - DVT group and non - metastatic spread group （P = 0. 000）. The cutoff value of TFPI - 1 in differential diagno- sis, prediction of DVT and metastatic spread of lung cancer was 52.3, 58.2, and 64.3ng/ml,the area under ROC curve was 0. 884（95% CI：0.811-0.958）, 0.957（95% CI：0.919-0.996）, and0.856（95% CI：0.774-0.938）（P〈0.05）,the sensitivity was 86.76%, 89.5% , and 82.1% ,and the specificity was 83.3% , 85.5% , and 82.5% , respectively. Compared with before treatment group, the levels of TFPI - 1 and AT significantly increased, but D - D level decreased in after treatment group （ P = 0. 000）. TFPI - 1 levels contin- uously increased in the four observed NSCLC patients since treatment started, however, just after treatment of at least 6 days, the levels of AT may start increasing and D - D decreasing. Conclusion There is important significance of plasma TFPI - 1 in differential diagnosis, disease conditions evaluation, and therapeutic observation of lung cancer patients.