恶性肿瘤患者凝血纤溶发生及标志物检测在血栓诊断中的作用

The occurrence of plasma coagulation and fibrinolysis in patients with malignant tumor and the role of detection of coagulation and fibrinolysis markers in the diagnosis of thrombus

目的:分析恶性肿瘤患者体内血浆凝血纤溶情况及凝血纤溶标志物在血栓诊断中的作用。方法:采用回顾性研究,收集132例恶性肿瘤患者的临床资料,根据手术前后血栓发生情况,分为术前无血栓组(73例)、术后无血栓组(36例)、血栓组(23例)。检测3组患者凝血功能标志物包括血小板计数、D-二聚体、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和纤溶标志物包括凝血酶-抗凝血酶III复合物(TAT)、血栓调节蛋白(TM)、纤溶酶-α2纤溶酶抑制剂复合物(PIC)、组织型纤溶酶原激活剂-抑制剂1复合物(t-PAIC)。结果:血栓组PT较术前无血栓组明显延长(P<0.05),血栓组APTT较术后无血栓组明显延长(P<0.05),血栓组与术后无血栓组血小板计数均明显低于术前无血栓组(P<0.05),血栓组D-二聚体明显高于术前无血栓组与术后无血栓组(P<0.05)。血栓组与术后无血栓组TAT、t-PAIC均明显高于术前无血栓组(P<0.05),血栓组TAT明显高于术后无血栓组(P<0.05)。血栓组与术前无血栓组TM均明显高于术后无血栓组(P<0.05)。血栓组PIC明显高于术前无血栓组与术后无血栓组(P<0.05)。D-二聚体、PIC及TAT诊断恶性肿瘤患者血栓形成的受试者工作特征曲线下面积分别为0.64、0.86、0.79,敏感度分别为52.17%、75.23%、73.91%,特异度分别为82.57%、91.30%、77.06%。结论:恶性肿瘤患者体内存在血浆凝血和纤溶活性异常改变的情况,并且PIC对患者血栓形成的诊断效能明显高于D-二聚体和TAT。

Objective:To analyze the plasma coagulation and fibrinolysis in patients with malignant tumor and the role of coagulation and fibrinolysis markers in the diagnosis of thrombus.Method:A retrospective study was conducted to collect the clinical data of 132 patients with malignant tumors.According to the incidence of thrombus before and after operation,the patients were divided into three groups:preoperative thrombus-free group(73 cases),postoperative thrombus-free group(36 cases)and thrombus group(23 cases).Platelet count,D-dimer,prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinolytic markers including thrombin-antithrombin complex(TAT),thrombomodulin(TM),α2-plasmin inhibitor-plasmin complexes(PIC),tissue plasminogen activator-inhibitor complexes(t-PAIC)were detected in three groups.Result:PT of thrombus group was significantly longer than that of preoperative thrombus-free group(P<0.05),APTT of thrombus group was significantly longer than that of postoperative thrombus-free group(P<0.05),platelet count of thrombus group and postoperative thrombus-free group were significantly lower than that of preoperative thrombus-free group(P<0.05),D-dimer of thrombus group was significantly higher than those of preoperative thrombus-free group and postoperative thrombus-free group(P<0.05).The TAT and t-PAIC of thrombus group and postoperative thrombus-free group were significantly higher than those of preoperative thrombus-free group(P<0.05),and the TAT of thrombus group was significantly higher than those of postoperative thrombus-free group(P<0.05).TM of thrombus group and preoperative thrombus-free group were significantly higher than that of postoperative thrombus-free group(P<0.05).PIC of thrombus group was significantly higher than those of preoperative thrombus-free group and postoperative thrombus-free group(P<0.05).The area under receiver operating characteristic curve of D-dimer,PIC and TAT was 0.64,0.86 and 0.79 respectively,the sensitivity was 52.17%,75.23% and 73.91%,the specificity was 82.57%,91.30% and 77.06%,respectively.Conclusion:There are abnormal changes of blood coagulation and fibrinolytic activity in patients with malignant tumors,and the diagnostic efficacy of PIC is significantly higher than those of D-dimer and TAT.