胃癌患者常规凝血试验与血栓弹力图相关性研究

Correlation between routine coagulation test and thromboelastography in patients with gastric cancer

目的:探讨胃癌患者常规凝血试验与血栓弹力图的相关性。方法:选择2019年1月—2020年11月于江苏省徐州市第一人民医院就诊的胃癌患者70例作为研究对象,根据国际抗癌联盟TNM分期标准分为I期组(n=11)、II期组(n=16)、III期组(n=33)、IV期组(n=10),根据肿瘤侵犯深度分为早期胃癌组(n=17)、进展期胃癌组(n=53),又根据是否转移分为转移组(n=24)、无转移组(n=46),遵循1∶1匹配原则选择70例同期来江苏省徐州市第一人民医院体检的健康者作为健康对照组,所有研究对象均行血栓弹力图、常规凝血试验及血常规检测,对检测结果进行分析,采用Pearson检验分析胃癌患者常规凝血试验与血栓弹力图的相关性。结果:II期组、III期组、IV期组患者的R值、K值及LY30值显著小于I期组、健康对照组,Angle角、MA值、Cl值及FIB、PLT、AT-III水平均显著大于I期组、健康对照组(P<0.05),且II期、III期、IV期组间患者分期越晚,其Angle角、MA值、Cl值及FIB、PLT、AT-III水平越大,R值、K值及LY30值越小,差异有统计学意义(P<0.05);早期胃癌组、进展期胃癌组患者的R值、K值及LY30值显著小于健康对照组,Angle角、MA值、Cl值及FIB、PLT、AT-III水平均显著大于健康对照组(P<0.05),且进展期胃癌组患者的R值、K值及LY30值显著小于早期胃癌组,Angle角、MA值、Cl值及FIB、PLT、AT-III水平均大于早期胃癌组(P<0.05);转移组患者的R值、K值及LY30值显著小于无转移组、健康对照组,Angle角、MA值、Cl值及FIB、PLT、AT-III水平均显著大于无转移组、健康对照组(P<0.05);Pearson相关性分析显示:胃癌患者R值、K值、LY30值与FIB、PLT、AT-III水平呈负比(r<0,P<0.05),Angle角、MA值、Cl值与FIB、PLT、AT-III水平呈正比(r>0,P<0.05)。结论:胃癌患者的血液处于高凝状态,不同TNM分期、不同浸润深度及有无淋巴结转移的胃癌患者之间常规凝血试验及血栓弹力图参数存在差异,动态监测有利于为临床提高有价值的凝血信息,血栓弹力图参数与特定常规凝血试验参数之间存在明显相关性,但不能相互替代。

Objective:To investigate the correlation between routine coagulation test and thromboelastography in patients with gastric cancer.Methods:70 patients with gastric cancer admitted to The First People’s Hospital of Xuzhou from January 2019 to November 2020 were selected and divided into stage I group(n=11),stage II Group(n=16),stage III group(n=33)and stage IV group(n=10)according to TNM staging standard of International Anti-cancer Union.According to tumor invasion depth,patients were divided into early gastric cancer group(n=17),advanced gastric cancer group(n=53),and metastasis group according to metastasis.According to the 1∶1 matching principle,70 healthy people who came to The First People’s Hospital of Xuzhou for physical examination at the same time were selected as the healthy control group.All subjects underwent thromboelastography,routine coagulation test and blood routine test.The test results were analyzed.Pearson test was used to analyze the correlation between routine coagulation test and thromboelastogram in patients with gastric cancer.Results:(1)The R value,K value and LY30 value of patients in stage II,III and IV groups were significantly lower than those in stage I group and healthy control group.The Angle angle,MA value,Cl value and the levels of FIB,PLT and AT-III in patients in stage II,III and IV groups were significantly higher than those in stage I group and healthy control group(P<0.05).(2)The R,K and LY30 values of patients with early gastric cancer and advanced gastric cancer were significantly lower than those of healthy controls.The Angle angle,MA value,Cl value,FIB,PLT and AT-III levels of patients with advanced gastric cancer were significantly lower than those of patients with early gastric cancer(P<0.05).The Angle angle,MA value,Cl value,FIB,PLT and AT-III levels of patients with advanced gastric cancer were significantly higher than those of patients with early gastric cancer(P<0.05).(3)The values of R,K and LY30 in the metastatic group were significantly lower than those in the non-metastatic group and healthy control group.The Angle angle,MA value,Cl value,FIB,PLT and AT-III levels in the metastatic group were significantly higher than those in the non-metastatic group and healthy control group(P<0.05);(4)Pearson correlation analysis showed that R value,K value and LY30 value of gastric cancer patients were negatively proportional to FIB,PLT and AT-III level(r<0,P<0.05).The Angle angle,MA value and Cl value were positively proportional to FIB,PLT and AT-III level(r>0,P<0.05).Conclusion:The blood of patients with gastric cancer is in hypercoagulable state.The parameters of routine coagulation test and thromboelastography are different among patients with different TNM stage,different depth of invasion and lymph node metastasis.Dynamic monitoring is helpful to improve valuable coagulation information for clinical practice.There is significant correlation between thromboelastogram parameters and specific conventional coagulation test parameters,but they can’t be replaced by each other.