免疫检查点抑制剂对晚期肺癌患者凝血功能的影响

Study of the effect of immune checkpoint inhibitors on coagulation function in lung cancer patients

目的探讨免疫检查点抑制剂(ICIs)治疗晚期肺癌时对患者凝血功能的影响。方法对2021年1月—2022年10月巴州人民医院收治的60例晚期肺癌适合应用免疫检查点抑制剂的患者,每周期治疗前、后分别抽取患者空腹新鲜静脉血3 mL,检验患者经ICIs治疗一、二周期前后凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、D-二聚体(D-D)及纤维蛋白原(FIB)、D-二聚体及血小板的变化。结果第一周期ICIs治疗后APTT、PT较治疗前降低,差异有统计学意义(P<0.05),PLT、D-二聚体、TT、FIB也均较治疗前降低,但差异无统计学意义(P>0.05)。第二周期治疗后凝血功能与治疗前差异无统计学意义(P>0.05)。但第二周期与第一周期相比PT、TT延长,差异有统计学意义(P<0.05)。结论ICIs治疗第一周期后APTT、PT降低,一定程度上加重了晚期肺癌患者高凝状态或血栓形成的风险;但是经过第二周期治疗后PT、TT延长,提示治疗有效后高凝状态或血栓形成风险会降低。

Objective To explore the effect of Immune checkpoint inhibitors(ICIs)on coagulation function in the treatment of advanced lung cancer.Methods In this study,60 patients with advanced lung cancer admitted to Bazhou People's Hospital who were suitable for the application of ICIs were treated with fasting fresh venous blood of 3 mL before and after each treatment cycle.The changes of thrombin time(APTT),prothrombin time(PT),thrombin time(TT),D-dimer(D-D)and fibrinogen(FIB),D-dimer and platelet before and after the first and second cycles of ICIs treatment were examined.Results APTT and PT decreased after the first cycle of immune checkpoint inhibitors,statistically significant(P<0.05).PLT,D-D,TT,and FIB were also decreased compared with those before treatment,but the difference was not statistically significant(P>0.05).There was no significant difference in coagulation function after the second cycle of treatment compared with before treatment(P>0.05).The second cycle was prolonged by PT,TT compared to the first cycle,with statistically significant differences(P<0.05).Conclusion APTT and PT decrease after the first cycle of ICIs treatment,which increase the risk of hypercoagulability or thrombosis in advanced lung cancer patients to a certain extent.However,PT and TT prolonge after the second cycle of treatment,suggesting that the hypercoagulable state or the risk of thrombosis will be reduced after effective treatment.