结肠直肠癌病人D-二聚体升高的研究

Study on D-dimer elevation in patients with colorectal cancer

目的:通过分析结肠直肠癌(colorectal cancer,CRC)病人凝血状态和相关临床资料,探索CRC与机体高凝的关系。方法:收集我院胃肠外科2018年8月至2019年12月手术治疗CRC病人的临床病理资料。以术前外周血D-二聚体水平为评估机体高凝状态的指标,回顾性分析影响CRC病人机体高凝状态发生的相关因素。结果:249例中104例(41.8%)术前血清D-二聚体高于正常上限(>550μg/L)。其中27例(10.8%)术前D-二聚体显著升高(高于正常上限的3倍,即>1650μg/L)。术后发生静脉血栓栓塞(venous thromboembolism,VTE)7例。多因素分析显示,肿瘤远处转移及脉管内肿瘤侵犯是术前D-二聚体升高的相关因素。肿瘤远处转移病人与无远处转移的术前D-二聚体异常升高占比分别为73.3%、37.6%(P<0.01)。脉管内肿瘤侵犯者和无脉管内肿瘤侵犯者术前D-二聚体异常升高占比分别为51.9%、34.3%(P<0.01)。按术前D-二聚体分组,正常组、升高组、显著升高组出现肿瘤远处转移的比例分别为2.8%、6.5%、22.2%,病理检查证实的脉管内肿瘤侵犯的比例分别为35.2%、48.1%、66.7%。两个比例都随术前D-二聚体水平升高而上升。3组VTE事件发生率分别为0.7%、3.9%、11.1%。VTE发生率与术前D-二聚体水平呈正相关。结论:肿瘤远处转移及脉管内肿瘤侵犯是导致CRC病人机体高凝状态的重要因素,可作为VTE风险的预测指标。

Objective To analyze the association of coagulation with clinical parameters in patients with colorectal cancer.Methods Clinical and pathological data in the patients with colorectal cancer and surgical treatment were collected from August 2018 to December 2019 in the Department of Gastrointestinal Surgery in our hospital.Retrospective analysis was performed to study the related factors to hypercoagulability with preoperative D-dimer value as index.Results A total of 104 from 249(41.8%)cases exhibited elevated D-dimer(>550μg/L)in serum preoperatively.Twenty-seven(10.8%)cases had a significant elevation of D-dimer(>1650μg/L)three times higher than normal limit.There were 7 cases with venous thromboembolism(VTE)postoperatively.Multivariate analysis showed that the preoperative elevated Ddimer in serum was associated with far metastasis and intraluminal invasion.Elevated D-dimer was found 73.3%cases with metastasis and 37.6%cases without metastasis(P<0.01),and 51.9%cases with intraluminal invasion and 34.3%without intraluminal invasion(P<0.01).Far metastasis was seen 2.8%in cases with normal D-dimer,6.5%with elevated D-dimer,and22.2%with significantly elevated D-dimer,and intraluminal tumor invasion diagnosed pathologically 35.2%,48.1%and66.7%in patients with normal,elevated and significantly elevated D-dimer,respectively.The incidence of VTE was 0.7%,3.9%and 11.1%in above three groups,which showed the statistical correlation of VTE with preoperative serum D-dimer level.Conclusions Far metastasis and intraluminal tumor invasion are important to induce hypercoagulability state in patients with colorectal cancer and to be as risk predictor of VTE.