肿瘤发生发展过程及预后评估中D-二聚体的临床意义

The significance of D-dimer in tumor development and prognosis

目的探讨肿瘤变化过程及预后评估中D-二聚体的临床意义。方法 (1)选择该院1 400例肿瘤患者与正常者D-二聚体水平的差异。(2)80例肿瘤患者手术前后血浆D-二聚体的分析,其中40例术后复发,40例术后无复发。(3)肿瘤患者并发弥散性血管内凝血(DIC)的D-二聚体进行分析,探讨D-二聚体对肿瘤患者伴发DIC的意义。结果 (1)与正常者比较,肿瘤患者D-二聚体明显增高,差异有统计学意义(P<0.05)。(2)术后无复发患者,手术前后D-二聚体比较,差异有统计学意义(P<0.05);术后复发患者,手术前后D-二聚体比较,差异无统计学意义(P>0.05)。(3)绘制四格表、受试者工作特征(ROC)曲线并行一致性检验得出,曲线下面积(AUC)=0.936,kappa=0.677,cut off值3.12mg,以高于正常值4倍以上的D-二聚体诊断肿瘤伴发DIC的方法效能较好,一致性较高。结论对肿瘤患者进行D-二聚体检测具有较高的临床意义,D-二聚体在肿瘤手术预后评估是一种标志物;以D-二聚体含量3.12mg/L为临界值可诊断肿瘤患者是否伴发DIC。

Objective To investigate the clinical significance of D-dimer in the process of tumor and prognosis.Methods （1）1 400 cases of caccer and 1 400 cases of healthy were collected from 452 Hospital of PLA over the past year,the level of D-dimer were compared.（2）80tumor patient′s preoperative and postoperative serum D-dimer levels were compared,including 40 patients with relapsed,and 40 patients recovered without recurrence.（3）D-dimer levels of tumor patients with disseminated intravascular coagulation（DIC）were detected,and to explore the significance of D-dimer in patients with tumor associated with DIC.Results （1）The D-dimer level of 1 400 cancer patients was significantly higher than the normal,and the difference is statistically significant（P〈0.05）.（2）The D-dimer value of 40 postoperative patients without recurrence were detected in preoperative and postoperative,the difference is statistically significant（P〈0.05）;The D-dimer value of 40 patients with tumor recurrence were detected in preoperative and postoperative,the difference is not statistically significant（P〉0.05）.（3）He datas from gold standard method and test diagnostic method were used to draw fourfold table,ROC curve and consistency test,showed that AUC=0.936,kappa=0.677,cut off value of 3.12mg/L,the value of D-dimer with higher than normal value of more than 4times to diagnose tumor associated with DIC has good performance and high consistency.Conclusion For the determination of D-dimer levels inferred tumor development has clinical significance,and D-dimer in the prognostic evaluation of tumors is a possible prognostic markers;The D-dimer level of 3.12mg/L is the critical value of the diagnosis of cancer patients associated with DIC.