肺癌患者化疗前后凝血、纤溶功能相关指标和血小板计数变化分析

Changes of coagulation and fibrinolysis function and PLT in patients with lung cancer before and after ;chemotherapy

目的：通过比较肺癌患者化疗前后外周血凝血、纤溶功能相关指标和血小板计数（PLT）的变化，探讨其与肺癌分期、化疗疗效的关系。方法选取接受治疗的肺癌患者80例为研究对象，观察化疗前和化疗2周期后凝血、纤溶相关指标[凝血酶原时间（PT）、凝血酶原时间国际标准化比值（PTINR）、活化部分凝血酶时间（APTT）、纤维蛋白原（Fib）、D-二聚体（D-D）、凝血酶时间（TT）]和 PLT 的变化情况，并分析上述指标与肺癌分期及化疗疗效的关系。结果化疗前 PT、PTNR、APTT、Fib、PLT、D-D、TT 分别为（11．34±1．14）s、（1．01±0．07）、（24．34±4．53）s、（2．54±0．45）g／L、（184．31±10．88）x109／L、（143．35±23．45）ng／mL、（14.55±4．56）s，化疗后分别为（11．57±1．36）s、（1．03±0．05）、（24．52±5．32）s、（3．63±0．65）g／L、（210.45±11．24）x109／L、（126．56±26．55）ng／mL、（14．34±4．17）s，化疗后患者的 Fib、PLT 含量较化疗前升高（t ＝0.024、0．025，P ＜0．05），D-D 较化疗前降低（t ＝0．001，P ＜0．05），PT、PTNR、APTT、TT 差异均无统计学意义（均 P ＞0．05）；与Ⅰ-Ⅱ期肺癌患者比较，Ⅲ-Ⅳ期肺癌患者 Fib 水平更高（t ＝0．01，P ＜0．05），其余各项差异均无统计学意义；化疗后，D-D 降低组38例，其中有效28例，无效10例，D-D 升高组42例有效12例，无效30例，两者比较差异有统计学意义（Z ＝－4．236，P ＝0．003）。化疗有效组和无效组 PT、PTINR、APTT、Fib、T-T 和 PLT 差异均无统计学意义（均 P ＞0．05）。结论化疗后 Fib、PLT 升高，D-D 降低；化疗后，D-D 降低组肿瘤缓解率更高，提示临床化疗过程中应关注 D-D 和 Fib 水平的变化。

Objective To investigate the changes of blood coagulation and fibrinolytic function and PLT in patients with lung cancer before and after chemotherapy,and to investigate the changes of the patients with lung cancer and the influence of the changes with lung cancer and the prognosis.Methods 40 patients with lung cancer（observation group）treated in our department from March 2012 to May 2014 were selected as the research subjects.The changes of coagulation and fibrinolytic activity,PT（PTINR）,APTT,thrombin time（Fib）,thrombin time（D -D）,thrombin time （TT）,D -D,and PLT were analyzed.The relationship between the parameters and the lung cancer staging was analyzed. Results Before chemotherapy,the levels of Fib,PLT,D -D,PT,PTNR,APTT,TT,PLT were （11.34 ±1.14）s, （1.01 ±0.07）,（24.34 ±4.53）s,（2.54 ±0.45）g/L,（184.31 ±10.88）x109 /L,（143.35 ±23.45）ng/mL, （14.55 ±4.56）s.After chemotherapy,the levels of Fib,PLT,D -D,PT,PTNR,APTT,TT,PLT were （11.57 ± 1.36）s,（1.03 ±0.05）,（24.52 ±5.32）s,（3.63 ±0.65）g/L,（210.45 ±11.24）＆#215;109 /L,（126.56 ±26.55）ng/mL, （14.34 ±4.17）s.The contents of Fib and PLT after chemotherapy were higher than before chemotherapy（t =0.024, 0.025,all P 〈0.05）,D -D decreased（t =0.001,P 〈0.05）,PT,PTNR,APTT,TT had no statistically significant changes（P 〉0.05）.Compared with patients with stage Ⅰ -Ⅱ lung cancer,Fib level in stage Ⅲ -Ⅳ lung cancer was higher （t =0.01,P 〈0.05）,and the rest of the patients with stage III and IV lung cancer had no significant difference.After chemotherapy,D -D decreased group（38 cases）,which effective in 28 cases,10 cases were ineffec-tive.D -D increased group（n =42）effective in 12 cases,invalid in 30 cases,the difference between two groups was statistically significant （Z =-4.236,P =0.003）.Chemotherapy effective group and ineffective group PT,PTINR, APTT,Fib,T -T and PLT had no statistically significant differences （all P 〉0.05）.Conclusion PLT and Fib were increased,but D -D decreased after chemotherapy,the tumor remission rate was higher in D -D group,which indica-ted that the levels of Fib and D -D should be changed in the course of clinical chemotherapy.