晚期非小细胞肺癌患者凝血功能异常的相关因素与预后的分析

Analysis of prognosis and factors of abnormal coagulation in patients with advanced non-small cell lung cancer

目的分析晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的凝血功能,并探讨其对预后和生存期的影响,为早期纠正凝血功能异常提供指导。方法选择2012年1月至2014年1月于本院就诊的60例经病理活检确诊的NSCLC患者纳入试验组,另选择本院同期60例健康体检者纳入对照组。通过比浊法检测两组研究对象的血浆凝血活酶时间(thromboplastin time,TT)、凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、纤维蛋白原(fibrinogen,FIB)水平、凝血酶原活动度(prothrombin activity,PTA)、国际标准化比值(international normalized ratio,INR)、D-二聚体(D-dimer,D-D)及血小板(platelet count,PLT)计数。采用Log-Rank检验和Cox比例风险回归模型分析凝血功能与患者生存期和预后的相关性。结果试验组患者PT、INR较对照组均显著延长(P<0.05),APTT、PTA较对照组均显著降低(P<0.05),FIB、D-D水平及PLT计数较对照组均显著升高(P<0.05),两组患者TT比较无显著差异(P>0.05)。不同年龄、不同肿瘤病理类型、不同肿瘤直径的患者其凝血功能指标比较均无显著差异(P>0.05)。与女性患者相比,男性患者PT、APTT、INR延长,PTA下降,FIB水平升高,差异均有显著性(P<0.05)。与淋巴结未转移患者相比,淋巴结转移患者的FIB、D-D水平均显著升高,APTT缩短,差异均有显著性(P<0.05)。试验组患者平均生存期为(20.3±18.2)个月。LogRank生存比较研究法提示:PT和INR延长、PTA下降及FIB水平升高均影响NSCLC患者的生存期和预后(P<0.05),其余指标与生存期和预后无明显相关性(P>0.05)。Cox比例风险回归模型提示:FIB水平升高和INR延长均为缩短NSCLC患者生存期并导致不良预后的独立危险因素(P<0.05)。结论晚期NSCLC常导致血液高凝状态,男性患者及淋巴结转移均会显著增加血液高凝状态,其中PT、INR、PTA及FIB水平与患者生存期显著相关,但仅FIB水平和INR是影响晚期NSCLC患者生存期和预后的独立危险因素。

Objective To analyze the prognosis and factors of abnormal coagulation in patients with advanced non-small cell lung cancer （NSCLC）, and to explore the influence on prognosis and survival, provide guidance for the early correction of abnormal coagulation function. Method 60 patients with NSCLC who were diagnosed in our hospital from January 2012 to January 2014 were included in experimental group, another 60 healthy person were selected as control group during the same period. By turbidimetric method, detected the plasma thromboplastin time （TT）, prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （FIB） levels, prothrombin activity （PAT）, intemational normalized ratio （INR）, D-dimer （D-D） and platelet count between the two groups. Study on the relationship between coagulation function and survival and prognosis of patients with Log-Rank test and Cox proportional hazards regression model. Result Comparedwith control group, the experimental group＇s PT and 1NR were longer, APTT, PTA were lower, FIB, D-D and platelet count were significantly higher than those in control group （P 〈 0.05）, there was no significant difference in TT between the two groups （P 3〉 0.05）. There were no significant differences in the indexes of coagulation in patients with different age, tumor type and tumor diameter （P 〉 0.05）. Compared with female patients, male patients with PT, APTT, INR prolonged, PTA decreased, FIB levels increased, the differences were significant （P 〈 0.05）. Compared with patients without lymph node metastasis, lymph node metastasis in patients with FIB, D-D levels increased significantly, APTT shortened, the differences were significant （P 〈 0.05）. The mean survival time of experimental group was （20.3__＋ 18.2） months. Log-Rank survival comparative study suggested that PT and INR prolongation, PTA declined and FIB levels rised had adverse effects on survival and prognosis in patients with NSCLC （P 〈 0.05）, the other indexs had no significant correlation between survival and prognosis （P 〉 0.05）. Cox proportional hazards regression model suggested that both FIB levels and INR prolongation were independent risk factors for shortening the survival and progression of NSCLC patients （P 〈 0.05）. Conclusion Advanced NSCLC often leads to a hypercoagulable state, and lymph node metastasis in patients with male significantly increase blood hypercoagulability, including PT, INR, PTA and FIB levels and patient survival are significantly related, but only the levels of FIB and 1NR are the independent risk factors on advanced NSCLC patients＇ survival and prognosis.