肺癌患者围手术期高凝状态的实验室指标特征及对深静脉血栓形成的诊断价值

Characteristics of Laboratory Biomarkers Associated with Hypercoagulability in Lung Cancer Patients During Perioperative Period and Its Diagnostic Value for Deep Venous Thrombosis

目的探讨肺癌患者围手术期高凝状态的实验室指标特征及对深静脉血栓形成(DVT)的诊断价值。方法143例围手术期患者均接受双下肢深静脉加压超声检查和实验室指标检测。对DVT(+)与(-)组围手术期水平变化有明显差异的实验室指标进行ROC曲线下面积分析(AUC)及找出诊断界值。结果术后第3~7天下肢DVT者33例。全组患者术后纤维蛋白原降解产物(FDP)、D-二聚体(D-Dimer)、脑钠肽和C反应蛋白水平在术后第1~7天均明显升高(P<0.05)。DVT(+)与DVT(-)组围手术期FDP和D-Dimer水平的变化差异有统计学意义(P<0.05),POD1(术后第1天)-FDP、POD3-FDP和POD3-D-Dimer的AUC和诊断界值分别为(0.726、4.65μg/ml)、(0.811、4.85μg/ml)和(0.772、1.55μg/ml),其联合诊断的串联试验敏感度为46.5%,特异度为94.9%。结论术后第1天及第3天FDP和术后第3天D-Dimmer水平增高对DVT的诊断价值中等,串联试验联合诊断可明显提高特异度。

Objective To analyze the characteristics of laboratory biomarkers associated with hypercoagulability in patients undergoing lung cancer surgery during the perioperative period and its diagnostic value for deep venous thrombosis(DVT).Methods We enrolled 143 patients treated with lung cancer surgery based on eligibility criteria.The lower extremity deep vein was examined perioperatively by compressed ultrasonic(CUS)to determine the DVT.The laboratory biomarkers associated with hypercoagulability were measured.We analyzed the area under curve(AUC)of ROC and cutoff in DVT(+)and DVT(-)groups with significant different biomarkers.Results Thirty-three patients with DVT were first diagnosed from the postoperative 3rd day(POD3)to 7th day(POD7).The fibrinogen degradation product(FDP),D-Dimer,brain natriuretic peptide and C reactive protein were significantly increased in the postoperative POD1-POD7(P<0.05).There were significant differences in the change levels of FDP and D-D during the perioperative period between the DVT(+)and DVT(-)groups(P<0.05).The AUC and diagnostic cutoff values of POD1-FDP,POD3-FDP,POD3-D-D were 0.726 and 4.65μg/ml,0.811 and 4.85μg/ml,0.772 and 1.55μg/ml,respectively.The sensitivity and specificity of serial test were 46.5%and 94.9%for the combined diagnosis.Conclusion The value of increased levels of POD1-FDP,POD3-FDP and POD3-D-Dimer for DVT diagnosis is moderate.The combined diagnosis with serial test could improve the specificity of diagnosis.