同型半胱氨酸D-二聚体和血清淀粉样蛋白A与非小细胞肺癌合并静脉血栓的相关性研究

Correlation between homocysteine D-dimer and serum amyloid A and non-small cell lung cancer complicated with venous thrombosis

目的探讨血清同型半胱氨酸(Hcy)、血浆D-二聚体和血清淀粉样蛋白A(SAA)在非小细胞肺癌(NSCLC)合并静脉血栓诊断中的应用价值。方法收集山西白求恩医院2018年6月至2020年5月收治的168例非小细胞肺癌患者,其中112例单纯非小细胞肺癌,56例非小细胞肺癌合并静脉血栓。收集同时期健康体检者93名作为对照组。分别检测3组人群血清Hcy、血浆D-dimer和血清SAA水平,并采用SPSS 23.0软件进行统计学分析。结果 NSCLC组血清Hcy水平为12.5(9.9,14.5)μmol/L,与健康对照组12.3(10.3,14.3)μmol/L相比,差异无统计学意义(P>0.05)。NSCLC组血浆D-dimer水平为257.5(124.5,545.0)ng/ml,与健康对照组110.0(90.0,146.0)ng/ml相比,差异有统计学意义(P<0.01)。NSCLC组血清SAA水平为10.8(4.9,42.0)mg/L与健康对照组3.5(2.8,5.2)mg/L相比,差异有统计学意义(P<0.01)。将NSCLC组进行TNM分期,NSCLCⅢ期和Ⅳ期与NSCLCⅠ期和Ⅱ期患者比较,D-二聚体和SAA差异均有统计学意义(P<0.01)。56例NSCLC合并静脉血栓组血清Hcy水平为15.5(12.8,19.1)μmol/L,血浆D-二聚体为865.0(592.3,1462.5)ng/ml,血清SAA水平为47.5(22.6,105.9)mg/L。与78例NSCLCⅢ期和Ⅳ期组比较,血清Hcy、血浆D-二聚体和血清SAA升高均具有统计学意义(P<0.01)。经ROC曲线分析,Hcy在NSCLC合并静脉血栓诊断中的ROC曲线下面积为0.715,面积标准误为0.036,P<0.01,95%CI:(0.644,0.786)。D-二聚体在NSCLC合并静脉血栓组诊断中的ROC曲线下面积为0.916,面积标准误为0.018,P<0.01,95%CI:(0.881,0.952)。SAA在NSCLC合并静脉血栓组诊断中的ROC曲线下面积为0.847,面积标准误为0.024,P<0.01,95%CI:(0.800,0.894)。结论 NSCLC合并静脉血栓组血清Hcy、血浆D-二聚体和血清SAA表达水平与单纯NSCLC组比较显著升高,有望成为NSCLC患者合并静脉血栓的早期预测指标。

Objective To investigate the use of serum homocysteine(Hcy),plasma D-dimer and serum amyloid A(SAA)in the diagnosis of non-small cell lung cancer(NSCLC)complicated with venous thrombosis.Methods The clinical data of One hundred and sixty-eight patients with NSCLC admitted to Shanxi Bethune Hospital between June 2018 and May 2020 were included in the study,including 112 cases of simple NSCLC and 56 cases of NSCLC complicated with venous thrombosis.A contemporary cohort of 93 healthy subjects was included in the control group.The levels of serum Hcy,plasma D-dimer and SAA were determined in the three groups,and SPSS 23.0 software was used for statistical analysis.Results There was no statistically significant difference in the serum Hcy level between the NSCLC group and the healthy control group[12.5(9.9,14.5)μmol/L vs 12.3(10.3,14.3)μmol/L,P>0.05].There was statistically significant difference in the plasma D-dimer level between the NSCLC group and the healthy control group[257.5(124.5,545.0)ng/ml vs 110.0(90.0,146.0)ng/ml,P<0.01].There was statistically significant difference in the serum SAA level between the NSCLC group and the healthy control group[10.8(4.9,42.0)mg/L vs(3.5(2.8,5.2)mg/L),P<0.01].TNM staging was performed in NSCLC group.Compared NSCLC stageⅢandⅣwith stageⅠandⅡ,there were statistically significant differences in plasma D-dimer and SAA levels(all P<0.01).The levels of Hcy,D-dimer and SAA in 56 patients with NSCLC complicated with venous thrombosis were 15.5(12.8,19.1)μmol/L,865.0(592.3,1462.5)ng/ml and 47.5(22.6,105.9)mg/L,respectively.Compared with 78 cases of NSCLC stageⅢand IV,there were statistically significant differences in the increase of serum Hcy,plasma D-dimer and serum SAA levels(all P<0.01).ROC curve analysis was used to examine Hcy,D-dimer and SAA in the diagnosis of NSCLC complicated with venous thrombosis,yielding an area under the curve(AUC)of 0.715,0.018 and 0.024,AUC standard error of 0.036,0.018 and 0.024,95%CI of 0.644,0.786,0.881,0.952 and 0.800,0.894,respectively,all P<0.01.Conclusion The expression levels of serum Hcy,plasma D-dimer and serum SAA in patients with NSCLC complicated with venous thrombosis significantly increases compared with those in the simple NSCLC group,and therefore can be promising as early predictors for patients with NSCLC complicated with venous thrombosis.