老年非小细胞肺癌患者低分割放疗对凝血功能的影响

Influence of Hypofractionated High-Dose Radiotherapy on Coagulation Function in Elderly Patients with Non-Small Cell Lung Cancer

目的探讨老年非小细胞肺癌患者凝血功能的变化及低分割放疗对凝血功能的影响。方法收集2013年1月～2016年3月在解放军第323医院首诊并仅接受胸部低分割放疗的老年非小细胞肺癌患者的临床资料,包含患者治疗前、后凝血功能指标:血浆凝血酶原时间(prothrombin time,PT)、纤维蛋白原(fibrinogen,Fib)、D-二聚体(D-dimer,D-D)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、血小板计数(platelet count,PLT),以及一般临床资料:性别、年龄、TNM分期和病理类型。三维适形低分割放疗方案,单次剂量2.5Gy,5次/周,总剂量35～50Gy。结果健康体检对照组共纳入39例,仅接受胸部放疗的老年非小细胞肺癌患者共纳入51例,老年肺癌组Fib,PLT和D-D水平明显高于对照组。老年非小细胞肺癌组患者的性别、年龄、病理分型对凝血功能影响差异无统计学意义(P>0.05);TNM分期中,Ⅲ～Ⅳ期较Ⅰ～Ⅱ期Fib和D-D明显升高,差异有统计学意义(t=-3.088,-2.218,均P<0.05)。放疗后1周Fib和D-D均显著高于放疗前,差异有统计学意义(t=-2.60,-2.57,均P<0.05)。结论低分割三维适形放疗短期内加剧了老年非小细胞肺癌患者凝血功能亢进。

Objective To investigate influence of hypofractionated high dose radiotherapy on coagulation function in elderly patients with non small cell lung cancer. Methods The clinical data of elderly patients with non small cell lung cancer who were first diagnosed in No. 323 Hospital of People＇s Liberation Army from January 2013 to March 2016 and received only hypofractionated high dose radiotherapy were collected, including the functional indexes of coagulation before and after treat ment：prothrombin time （PT）, fibrinogen （Fib）, I^dimer, activated partial thromboplastin time （APTT）, platelet count （PLT）, and clinical data of all patients：sex, age, TNM stage and pathological type. Dose fractionation 2.5Gy/d, 5f/w, total dose 35Gy^55Gy. Results Levels of Fib, PLT and D D in lung cancer group were significantly higher than the control group （P〈0.05）. Sex,age and pathological on coagulation function in elderly patients with non small cell lung cancer were no significantly higher （P〈0.05）. Levels of Fib and D-D Ⅲ-IV stage were significantly higher than I ~ Ⅱ stage （t=- 3. 088, 2. 218, all P〈0.05）. The level of Fib and D D at the time points of 1 weeks after hypofractionated high dose radio therapy were significantly higher than those at the time point of 0 week after hypofractionated high dose radiotherapy （t=- 2.60, 2.51,all P〈0.05）. Conclusion Three dimensional conformal hypofractionated high dose radiotherapy may aggra vate the augmentation of coagulation function in elderly patients with non small cell lung cancer in the short term.