肿瘤相关易栓症患者实验室指标的变化及临床意义

Changes and clinical significance of laboratory indexes in patients with tumor associated thrombophilia

目的:探讨活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶原时间(prothrombin time,PT)、凝血酶时间(thrombin time,TT)、纤维蛋白原(fibrinogen,FIB)、D-二聚体(D-dimer,DD)、红细胞(red blood cell,RBC)、血红蛋白(hemoglobin,HGB)、红细胞压积(hematocrit,HCT)、血小板(platelet,PLT)、平均血小板体积(mean platelet volume,MPV)及球蛋白(globulin,GLO)、甘油三酯(triglyceride,TG)、高密度脂蛋白(high density lipoprotein,HDL)在肿瘤相关易栓症患者中的变化及临床意义。方法:病例组136例,分为肿瘤组76例,包括非霍奇金淋巴瘤(non-Hogkin lymphoma,NHL)19例、胃癌(gastric cancer,GC)30例、肺癌(lung cancer,LC)27例。均为初治病例,于化疗后1月纳入统计。非肿瘤-深静脉血栓形成组(non-tumor deep vein thrombosis,NT-DVT)60例,均为确诊的下肢DVT患者,抗凝治疗后2周纳入统计。对照组90例,来自本院门诊健康体检者。经全自动血凝仪、全自动血球仪及全自动生化分析仪检测APTT、PT、TT、FIB、D-D、RBC、HGB、HCT、PLT、MPV及GLO、TG、HDL水平变化。结果:肿瘤组患者化疗前D-D表达水平升高(P<0.05),化疗后下降(P<0.05)。肿瘤组患者化疗前HDL表达水平下降(P<0.05),化疗后升高(P<0.05)。肿瘤组患者化疗前FIB、PLT、GLO表达水平升高(P<0.05)。NT-DVT组治疗前APTT、FIB、D-D表达水平升高(P<0.05),治疗后APTT延长(P<0.05),FIB、D-D下降(P<0.05)。结论:D-D、FIB、PLT、GLO、HDL水平是反映肿瘤相关易栓症患者血栓前状态的良好指标。

Objective：To explore changes and their clinical significance of activated partial thromboplastin time （ APTT）, prothromhin time （ PT）, thromhin time （ TT）, fihrinogen （ FIB ）, D-dimer （ D-D ）, red blood cell （ RBC ）, hemoglobin （ HGB）, hematocrit （ HCT ）, platelet （ PLT ）, mean platelet volume （ MPV ）, globulin （ GLO ）, triglyceride （TG） and high density lipoprotein（HDL） in patients with tumor associated thrombophilia. Methods ：136 patients were divided into tumor group and NT-DVT group. Tumor group included 19 non-Hogkin lymphoma, 30 gastric cancer,27 lung cancer. The samples that are all previously untreated were collected 1 month after chemotherapy. NT-DVT group had 60 patients who were already diagnosed with DVT of lower extremity. The samples were collected 2 weeks after anticoagulant therapy. The control group was composed of 90 healthy cases from outpatient. Automatic co-agulation analyzer,automatic hematology analyzer and automatic biochemistry analyzer were used to detect the level changes of APTT, PT, TT, FIB, D-D, RBC, HGB, HCT, PLT, MPV, GLO, TG and HDL. Result ： The expression level of D-D in tumor group was higher than control group before chemotherapy and decreased after chemotherapy（P 〈 0.05 ）. The expression level of plasma HDL in tumor group was lower than control group before chemotherapy and increased after chemotherapy（ P 〈 0.05 ）. The expression level of plasma FIB, PLT and GLO in tumor group were higher than control group before chemotherapy（ P 〈 0.05 ）. The expression level of plasma APTT, FIB and D-D in NT-DVT group were higher than control group before treatment. After treatment, the level of APTT increased （ P 〈 0.05） , but the level of FIB and D-D decreased （ P 〈 0.05 ）. Conclusion ： D-D, FIB, PLT, GLO and HDL are good markers in reflecting the pre-thrombosis status of patients with tumor associated thromhophilia.