恶性实体瘤合并弥散性血管内凝血的临床治疗探讨

Discussion on Malignant Solid Tumor combined with Disseminate Intravascular Coagulation(DIC) Clinical Treatment

目的探讨多因素对恶性实体瘤合并弥散性血管内凝血治疗疗效的影响。方法选取2006年9月至2016年9月间收治的167例恶性实体瘤合并弥散性血管内凝血患者,对其进行病因治疗,抗凝和(或)替代治疗等对症治疗后,观察临床效果,并分析多因素对治疗有效率的影响。结果 167例DIC患者,以消化道肿瘤和肺癌较为多见。年龄≥60岁组的DIC患者治疗有效率高于<60岁组(52.0%VS 28.3%,P<0.05)。合并感染的患者治疗有效率低于不合并感染的患者,但差别无统计学意义(34.7%VS 44.9%,P>0.05)。无瘤负荷DIC患者治疗有效率明显高于有瘤负荷DIC患者(82.9%VS 27.3%,P<0.05)。在无瘤负荷组,抗凝治疗和替代治疗疗效无明显差异(P>0.05);在有瘤负荷组,抗凝组疗效高于替代治疗组(33.7%VS 6.5%,P<0.05)。在DIC治疗有效的患者中,有瘤负荷组接受>6150 IU抗凝剂量所占比例明显高于无瘤负荷组(61.1%VS24.1%,P<0.05)。结论恶性实体瘤合并弥散性血管内凝血转归受多因素影响。在治疗原发病的同时,适量的抗凝治疗是提高治疗有效率的重要手段。

Objective To discuss multiple factors effects on malignant solid tumor combined with disseminate intravascular coagulation （DIC） therapeutic evaluation. Method A total of 167 subjects of malignant solid tumor combined with disseminate intravascular coagulation （2006-09 to 2016-09） was treated etiologically for anticoagulant and replacement therapy. Multiple factors effects on curative efficacy were evaluated by curative efficacy. Results Gastrointestinal tumors accounted for the large proportion of total subjects. DIC subjects over 60 years （52.0%） had better curative efficacy than subjects less than 60 years （28.3%） with a significant difference （P〈0.05）. Curative efficacy was lower in co-infection subjects （34.7%） than other subjects （44.9%） while the difference was not significant （P〉0.05）. Curative efficacy was higher in DIC subjects with no tumor burden （82.9%） than DIC subjects with tumor burden （27.3%） and the difference was significant （P〈0.05）. Within the DIC subjects with no tumor burden, no significance was obtained between anticoagulant and replacement therapy （P〉0,05）; within the DIC subjects with tumor burden, curative efficacy was higher in anticoagulant therapy （33.7%） than replacement therapy （6.5%） and the difference was significant （P〈0.05）. For DIC subjects with effective treatment, more tumor burden subjects （61.1%） than no tumor burden subjects （24.1%） received anticoagulation dosage over 6150 IU, and the difference was significant （P〈0.05）. Conclusion The prognosis of malignant solid tumor combined with disseminate intravascular coagulation （DIC） was influenced by multiple factors. In addition to primary disease treatment, moderate anticoagulation treatment was an important approach to achieve a higher curative efficacy.