肿瘤患者同型半胱氨酸与静脉血栓及凝血功能的相关性研究

The relation of plasma homocysteine levels to venous thrombosis and coagulation function in tumor patients

目的:研究血浆同型半胱氨酸(Hcy)水平与肿瘤患者静脉血栓(VTE)及凝血功能的相关性,同时探讨肿瘤患者发生静脉血栓的相关危险因素,为临床治疗提供参考。方法:检测182例发生VTE的肿瘤患者和200名普通肿瘤患者及200名健康体检者(对照组)血浆Hcy、D-二聚体(D-Dimer,D-D)、纤维蛋白原(FIB)、凝血因子VIII(FVIII)、组织纤维溶酶原激活物(t-PA)等指标。结果:VTE患者Hcy、D-D、FVIII、FIB及t-PA检测水平均高于普通肿瘤患者及健康体检者(P<0.05);而普通肿瘤患者组D-D、FIB水平高于健康体检者(P<0.05);Hcy、D-D检测VTE的ROC曲线下面积分别为0.72(95%CI:0.68~0.79)和0.77(95%CI:0.72~0.83);VTE肿瘤患者组中,Hcy、D-D血液含量存在明显的相关性(P=0.0033,r=0.622);高Hcy水平、D-D高水平以及t-PA血浆含量高是肿瘤患者发生VTE的危险因素。结论:Hcy水平能有效反映治疗患者的凝血状态,监测Hcy及D-D水平可以提高VTE的诊断效率,对肿瘤患者的预后有重要的临床参考价值。

Objective:To investigate the correlation between plasma homocysteine(Hcy)level and venous thrombosis(VTE)and coagulation function in tumor patients,and to explore the related risk factors of venous thrombosis in tumor patients,to provide reference for clinical treatment.Methods:We identified 182 tumor patients with VTE,200 tumor patients and 200 healthy subjects(control group).Serum Hcy level,D-Dimer(D-D),fibrinogen(FIB),coagulation factor VIII(FVIII),tissue fibrinogen activator(t-PA)were measured.Results:The serum levels of Hcy,D-D,FVIII,FIB and t-PA in VTE patients were significantly higher than those in normal tumor patients and healthy control group(P<0.05).And the level of D-D and FIB in the normal tumor group was higher than that in the healthy control group(P<0.05).The area under the ROC curve of Hcy and D-D detection of VTE was 0.72(95%CI:0.68~0.79)and 0.77(95%CI:0.72~0.83),respectively.In the VTE tumor group,Hcy and D-D levels were significantly correlated(P=0.0033,r=0.622).High Hcy level,high D-D level and high plasma t-PA were risk factors for VTE in tumor patients.Conclusion:Hcy can effectively reflect the coagulation status of patients,and monitoring of Hcy and D-D levels can improve the diagnostic efficiency of VTE,which has important clinical reference value for the prognosis of tumor patients.