TEG联合血浆D-Dimer、FIB检测在恶性肿瘤患者预后评估中的应用探析

Application of TEG Combined with Plasma D-Dimer and FIB Detection in the Prognosis Evaluation of Patients with Malignant Tumors

目的:探析血栓弹力图(TEG)联合血浆D-二聚体(D-Dimer,D-D)、纤维蛋白原(FIB)检测在恶性肿瘤患者预后评估中的应用效果。方法:回顾性分析2018年11月-2019年11月入住笔者所在医院的102例恶性肿瘤患者的临床资料,根据治疗后患者预后情况分为肿瘤复发组42例和肿瘤缓解组60例。比较两组TEG参数[凝血反应时间(R值)、血凝块形成时间(K值)、凝血形成速率(Angle角)、最大振幅(MA值)、凝血综合指数(CI值)]及D-D、FIB水平差异,以受试者工作特征(ROC)曲线评估上述指标单独应用及联合应用对两组患者预后的预测价值。结果:肿瘤缓解组R值、K值均高于肿瘤复发组,Angel角、MA值、CI值均低于肿瘤复发组,D-D、FIB水平均低于肿瘤复发组,差异均有统计学意义(P<0.05)。TEG(CI值)、D-D、FIB预测患者预后ROC曲线下面积(AUC)分别为0.914、0.948、0.750,灵敏度为84.13%、87.18%、95.24%,特异度为84.62%、90.48%、61.54%,截断值为1.63、0.94 mg/L、4.22 g/L;三者联合预测患者预后AUC为0.993,灵敏度为95.24%、特异度为97.44%,联合预测AUC均高于单独预测,差异均有统计学意义(P<0.05)。结论:TEG联合D-D、FIB对恶性肿瘤患者预后有较高预测价值,对三种指标进行有效检测,有助于科学评估患者生存状态,为治疗提供一定参考依据。

Objective:To explore the application effects of thromboelastography (TEG) combined with plasma D-dimer (D-D) and fibrinogen (FIB) detection in the prognosis evaluation of patients with malignant tumors.Method:The clinical data of 102 patients with malignant tumors admitted to our hospital from November 2018 to November 2019 were retrospectively analyzed.According to the prognosis of patients after treatment,they were divided into the tumor recurrence group (42 cases) and the tumor remission group (60 cases).The TEG parameters[coagulation reaction time (R value),blood clot formation time (K value),blood coagulation rate (Angle angle),maximum amplitude (MA value),coagulation comprehensive index (CI value)]and levels of D-D and FIB were compared between the two groups.The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the above indicators alone or in combination on prognosis of the two groups.Result:The R value and K value in the tumor remission group were higher than those in the tumor recurrence group,and the Angel angle,MA value and CI value were lower than those in the tumor recurrence group,and the levels of D-D and FIB were lower than those in the tumor recurrence group,the differences were statistically significant (P<0.05).The areas under the ROC curve (AUC) of TEG (CI value),D-D,and FIB in predicting the prognosis of patients were 0.914,0.948,and 0.750,and the sensitivities were 84.13%,87.18%,and 95.24%,and the specificities were 84.62%,90.48%,and 61.54%,and the cutoff values were 1.63,0.94 mg/L,and 4.22 g/L.The AUC,sensitivity and specificity of combination of the three were 0.993,95.24%,and 97.44%.The AUC of combined prediction was significantly greater than those of single prediction,the differences were statistically significant (P<0.05).Conclusion:TEG combined with D-D and FIB has a high predictive value on prognosis of patients with malignant tumors.The effective detection of the three indicators can help scientifically assess the survival status of patients and provide a certain reference for treatment.