NSCLC患者血凝状态的危险因素及药物干预的临床研究

High Coagulation Status and Drug Intervention in Patients with Non-Small Cell Lung Cancer

[目的]探讨非小细胞肺癌(NSCLC)患者血凝状态的危险因素及小剂量普通肝素对其血栓性疾病的防治作用。[方法]以35名健康体检人群的血浆凝血指标及血小板作为正常参照。94例确诊为NSCLC患者的临床资料分为治疗组(小剂量普通肝素+化疗)和单纯化疗组,所有化疗均采用顺铂为主的联合化疗方案。观察三组的凝血指标变化、血小板、血栓发生情况及毒副作用。[结果]NSCLC患者血浆纤维蛋白原(Fib)升高达50.4%,最高达7.52g/l(正常范围:2~4g/l),D-二聚体升高达24.3%,最高达2.18mg/l(正常范围:0~1mg/l)。D-二聚体、Fib水平均明显高于健康体检人群(P<0.05)。NSCLC经过小剂量普通肝素处理后,Fib、D-二聚体及血小板均有明显下降(P<0.01),APTT时间有明显缩短(P<0.01)。治疗组静脉血栓发生率明显降低(P<0.05)。[结论]NSCLC患者存在凝血异常,血浆D-二聚体、Fib、APTT的水平可作为预测血栓发生的危险因素。应用小剂量普通肝素能有效预防深静脉血栓的发生,未见普通肝素的毒副作用。

[Objective] To investigate the coagulation status in patients with non-small cell lung cancer（NSCLC） and its drug intervention.[Methods] Ninety four NSCLC patients were randomly divided into two groups：48 patients received chemotherapy and small dose unfractionated heparin（UFH）（study group） and 46 patients received chemotherapy alone（control group）;35 cases healthy subjects served as normal control group.The changes of coagulation parameters,platelet,thrombosis and adverse effects were observed in three groups.[Results] The plasma fibrinogen（Fib）and D-D dimer levels in NSCLC patients were significantly higher than those in healthy controls（3.82±0.094 vs 2.56±0.051,T=1.76,P=0.000;0.45±0.121 vs 0.38±0.057,T=2.26,P=0.027）.After unfractionated heparin treatment,the level of D-dimer in NSCLC patients was significantly decreased（P〈0.05） and APTT significantly shortened（P〈0.05）.The incidence rate of venous thrombosis in study NSCLC group was significantly lower than that in control group（P〈0.05）.[Conclusion] NSCLC patients have abnormal coagulation status.Low dose UFH can improve the high coagulation and fibrinolysis in patients with NSCLC.