血浆D-D、凝血因子、PC变化与乳腺癌根治术后发生DVT的多因素研究

Multivariate Study on the Relationship between Plasma D-D,Coagulation Factors,PC Changes and DVT after Radical Mastectomy

目的探讨血浆D-二聚体(D-D)、凝血因子、血浆蛋白C(PC)与乳腺癌根治术后发生下肢深静脉血栓(DVT)的关系。方法选取接受乳腺癌根治术治疗且术后发生DVT的患者45例作为病例组,同期接受乳腺癌根治术未发生DVT的患者90例作为对照组;统计并分析两组的年龄、体质量指数(BMI)、乳腺癌病理学类型、肿瘤淋巴结转移分期(TNM)、辅助化疗、合并疾病情况、红细胞(RBC)、纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)、D-D、凝血因子Ⅷ(FⅧ)、血浆PC的水平,并采用向前Logistic回归分析法分析D-D、FⅧ、血浆PC与乳腺癌根治术后发生DVT的关系。结果两组年龄、体质量指数(BMI)、患侧分布、病理学类型、TNM分期、高血压、糖尿病、RBC、TT水平比较,差异无统计学意义(P>0.05),病例组的辅助性化疗患者占比、FIB水平均高于对照组,PT、APTT水平均低于对照组(P<0.05);病例组D-D、FⅧ水平高于对照组(P<0.05);病例组血浆PC水平低于对照组(P<0.05);Logistic回归模型结果显示FIB增高、D-D升高、FⅧ水平升高及APTT水平降低是乳腺癌根治术术后发生DVT的独立危险因素(OR=1.602,2.042,2.134,1.430,P<0.05)。结论引起乳腺癌术后发生DVT的因素众多,D-D、FⅧ水平升高会显著的增高乳腺癌根治术后发生DVT的风险。

Objective To investigate the relationship between plasma D-dimer(D-D),coagulation factors,and plasma protein C(PC)and the occurrence of lower extremity deep vein thrombosis(DVT)after radical mastectomy of breast cancer.Methods 45 patients with DVT after breast cancer radical surgery were selected as the case group,and 90 patients without DVT after breast cancer radical surgery were selected as the control group.The age,body mass index(BMI),pathological type of breast cancer,tumor lymph node metastasis staging(TNM),adjuvant chemotherapy,combined diseases,red blood cell(RBC),fibrinogen(FIB),prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),D-D,coagulation factor VIII(F VIII),and plasma PC levels of the two groups were statistically analyzed.The relationship between D-D,FⅧ,plasma PC and DVT after radical surgery for breast cancer was analyzed by forward logistic regression analysis.Results There was no significant difference in age,BMI,affected side distribution,pathological type,TNM stage,hypertension,diabetes,RBC,and TT levels between the case group and the control group(P>0.05).The percentage of patients with adjuvant chemotherapy and FIB measurements in the case group were higher than those in the control group,PT and APTT measurements were lower than those in the control group(P<0.05),and D-D and FⅧlevel measurements in the case group were higher than those in the control group(P<0.05).Plasma PC levels in the case group were lower than those in the control group(P<0.05).The results of the logistic regression model showed that increased FIB,increased D-D,increased FⅧlevels and decreased APTT levels were independent risk factors for the development of DVT after radical mastectomy for breast cancer(OR=1.602,2.042,2.134,1.430,P<0.05).Conclusion There are many factors that cause DVT after breast cancer,and the increase of D-D,FⅧlevels will significantly increase the risk of DVT after breast cancer radical operation.