恶性肿瘤合并血栓形成的血小板参数变化临床研究

 目的 研究血小板参数在恶性肿瘤及恶性肿瘤合并血栓形成的变化，以便早期干预。方法 统计分析该院2002年7月至2004年3月恶性肿瘤住院患者200例，选择应用同一血细胞分析仪测定血小板参数患者共168例。分为血栓组和非血栓组。测定血小板计数（Plt）、血小板压积（PCT）、血小板平均体积（MPV）、血小板分布宽度（PDW）。结果 血栓组与非血栓组比较Plt明显增高，PCT增加明显，MPV、PDW增加无统计学意义；血栓组较正常对照组比较Plt明显增高，PCT 减小明显，MPV明显增高、PDW增加无统计学意义；非血栓组较正常对照组比较Plt及PCT明显减小，MPV、PDW增加无统计学意义。结论 血小板参数Plt、PCT、MPV，可作为恶性肿瘤合并血栓形成的早期预防指标，以便早期进行干预。     

特发性血小板减少性紫癜与人类疱疹病毒6型感染关系初探

目的：了解特发性血小板减少性紫癜与人类疱疹病毒6型（HHV－6）感染间的关系。方法：聚合酶链反应（PCR）检测特发性血小板减少性紫癜（ITP）骨髓，外周血中的HHV－6－DNA健康体检者和缺铁性贫血者为对照组。结果：20例ITP患者，10例缺铁性贫血患者和30例健康体检者外周血的HHV－6－DNA检出率分别为25％（5／20），10％（1／10）和3．33％（1／30），ITP患者组与健康体检组间，差异有显著性（P＜0．05）。ITP患者组与缺铁性贫血组间差异无显著性。15例ITP患者骨髓和10例缺铁性贫血患者骨髓，HHV－6－DNA检出率分别为46．67％（7／15）和0，二者间差异有显著性（P＜0．05）。10例ITP治疗前，治疗后第5天，第10天时外周血HHV－6－DNA检测，分别有3，3，2例阳性。结论：ITP与HHV－6的感染呈正相关，骨髓中HHV－6－DNA检出率高于外周血中     

化疗对肺癌患者凝血功能的影响作用及意义分析

目的：探讨化疗对肺癌患者凝血功能的影响及其临床意义。方法检测40例肺癌住院化疗患者（病例组）及同期体检健康人群40例（健康组）的凝血功能相关指标：凝血酶原时间（ PT）、纤维蛋白原（ FIB）、部分活化凝血酶原时间（APTT）、血小板计数（PLT）、血小板压积（PCT）、平均血小板体积（MPV）、血小板分布宽度（PDW）。结果肺癌患者（病例组）化疗前PT、FIB、APTT、PLT、PCT、MPV、PDW值均显著大于健康组（ P＜0．05）。不同临床分期、病理类型肺癌患者的PT、FIB、APTT、PLT、PCT、MPV、PDW值比较差异均不显著（ P＞0．05）。40例肺癌患者化疗前与化疗后PT、FIB、APTT、PLT、PCT、值比较差异显著（P＜0．05）,化疗后较化疗前均有所改善,MPV、PDW值在化疗前后差异不显著（P＞0．05）。结论晚期肺癌患者存在凝血功能异常,与肿瘤临床分期、病理类型无明显相关性;通过化疗可逐步改善患者的凝血功能。     

41例乳腺癌患者血小板膜糖蛋白变化分析

[目的]探讨乳腺癌患者外周血血小板膜糖蛋白CD62P、CD63水平变化的临床意义。[方法]采用流式细胞术检测40例健康人（正常对照组）和41例术前乳腺癌患者外周血血小板膜糖蛋白（CD62P、CD63）水平。[结果]乳腺癌患者外周血血小板膜糖蛋白水平（单纯血小板活化水平：CD62P2．04％±1．41％，CD63 1．64％±0．93％；黏附在细胞上的血小板活化水平：CD62P 12．54％±8．35％，CD6318．27％±14．86％；外周血血小板总的活化水平：62P2．58％±1．69％，CD63，2．21％±1．24％）明显高于正常对照组（单纯血小板活化水平：62P 1．04％±0．45％，CD630．64％±0．29％；黏附在细胞上的血小板活化水平：62P2．19％±0．85％，CD63 3．23％±1．64％；外周血血小板总的活化水平：62P 1．48％±0．40％，CD631．29％±0．35％），差异有显著性（P〈0．01）。乳腺癌患者62P、CD63水平变化分别受年龄、临床分期、手术与否及肿瘤有无转移等因素影响。[结论]外周血血小板膜糖蛋白水平可能成为监测乳腺癌患者病情进展的动态指标。     

MPV和PCT测定在恶性肿瘤患者反复血小板输注中的应用

目的 探讨血小板（PLT）减少时，肿瘤患者血小板参数MPV和PCT测定的变化规律。方法 采用SE9000全自动血液分析仪对56例反复输入血小板的恶性肿瘤患者进行血小板计数（PC）、血小板平均体积（MPV）和血小板压积（PCT）的分析比较，并同时对52例正常体检者进行血小板参数的测定。结果 反复输入血小板有效的恶性肿瘤患者，其MPV和PCT与反复输入血小板无效的恶性肿瘤患者比较，差异有统计学意义（P〈0．01，P〈0．05），与正常对照组比较差异无统计学意义（P〉0．05），反复输入血小板无效的恶性肿瘤患者与正常对照组比较，差异有统计学意义（P〈0．01）。结论 对于多次输注血小板的恶性肿瘤患者，除考虑患者体内易产生PLTAb导致PLT输注无效外，输注PLT前还应对患者的血小板参数进行密切观察，保证PLT输注的有效性。     

动态观察乳腺癌手术前后血小板参数及凝血功能变化对病情发展及疗效评价的意义

目的探讨乳腺癌手术前后血小板参数及凝血功能变化对病情发展的临床意义。方法用全自动血球计数仪SF-3000以及凝血仪检查乳腺癌80例和良性乳腺疾病80例术前及术后全血以及凝血功能。结果乳腺癌患者术前组PLT、MPV与对照组差异无统计学意义（P〉0．05），而与术后组差异有统计学意义（P〈0．05）；PDW差异无统计学意义（P〉0．05）；术后组与对照组PLT、MPV差异有统计学意义（P〈0．05），而PCT及PDW差异无统计学意义（P〉0．05）；乳癌手术前后凝血酶原时间（PT）差异无统计学意义（P〉0．05），而纤维蛋白原含量（FiB）术后明显高于术前（P〈0．05）；活化部分凝血酶原时间（APTT）术后明显低于术前（P〈0．05）。结论动态观察乳腺癌手术前后血小板参数可能作为一个新的预后因子，而凝血功能变化可作为判断患者病情发展及疗效评价的参考指标，对防治乳腺癌具有重要的临床意义。     

自体CIK回输对转移性恶性肿瘤细胞免疫指标变化的影响

目的探讨CIK治疗前后不同时间点T细胞亚群变化对恶性肿瘤临床疗效的影响。方法采用流式细胞术对71例恶性肿瘤患者外周血T细胞亚群进行检测。结果与非转移组比较,转移组T淋巴细胞亚群绝对数值增高（P〈0．01）,乳腺癌肺转移（15例）Th、NK指标高于均值（35．67±5．28和25．62±7．24）,增幅比率41．6％（15／36）,CD4＋／CD8＋绝对值增幅〉45％（由0．8±0．3到1．7±0．6;P〈0．01）。转移组总有效率52．8％,非转移组总有效率91．4％。结论CIK治疗对肿瘤负荷的缓解作用和提高疗效方面具有一定的临床意义。     

术前外周血血小板/淋巴细胞比值和血小板相关指标对晚期下咽鳞癌的预后价值

目的：探讨术前外周血血小板/淋巴细胞比值（PLR）和血小板相关指标（血小板平均体积MPV、血小板分布宽度PDW）对晚期（TNM Ⅲ/Ⅳ）下咽鳞癌患者长期预后的影响。方法：回顾性分析2003年1月至2012年12月我院诊治的176例晚期下咽鳞癌患者临床资料。使用X-tile法对术前血指标（PLR、PLT、MPV、PDW、MPV/P、PDW/P）选取最佳截点（cut-off point）区分高、低两组。应用Pearson或精确卡方检验对两组进行描述性分析,采用单因素和多因素Cox回归模型分析两组患者的PLR及其它临床病理因素与5年总生存期（OS）、5年无病生存期（DFS）的关系。结果：随访时间至2017年12月31日,平均随访时间（47.81±30.48）月。X-tile分析得出5年OS最佳截点：PLR为170.8, PLT为260×109/L, MPV为8.2fL, PDW为16.5%, MPV/P为0.036, PDW/P为0.0635;5年DFS最佳截点：PLR为139.6, PLT为271×109/L, MPV为11.1fL, PDW为16.5%, MPV/P为0.036, 和PDW/P为0.0635,TNM Ⅲ期较Ⅳ期生存率高（40.8% vs 25.2%）,T1-T2组生存率则较T3-T4组高（47.8% vs 11.5%）。纳入单因素及多因素Cox分析得出影响5年OS的独立危险因素有：高PLR（170.8）、高PLT（260×109/L）、低MPV（8.2fL）、T分级、术后转移。影响5年DFS的独立危险因素有：高PLR（139.6）、高PDW（11.1%）、T分级、TNM分期。结论：PLR升高提示下咽鳞癌患者预后较差,或可作为其长期预后（5年OS、DFS）评估指标。     

胸上段食管癌3DCRT与IMRT的剂量学比较

目的：比较胸上段食管癌三维适形放射治疗（3D-CRT）与调强放射治疗（IMRT）放疗剂量学的差异,为临床医师选择放疗方案提供参考。方法收集25例胸上段食管癌病例（临床分期为Ⅰ～Ⅲ期）,应用Oncentra三维放射治疗计划系统分别对每一位患者的靶区进行3D-CRT和IMRT治疗计划设计,拟定95％PTV处方剂量为60 Gy。通过剂量体积直方图（ DVH）参数,对95％等剂量线所包括的PTV体积百分比（V95）、靶区适形度指数（CI）、剂量不均匀指数（HI）和危及器官所受照射剂量进行对比分析。结果 IMRT和3D-CRT两种不同放疗计划：V95分别为（99．91±0．14）％、（95．73±4．14）％,差异有统计学意义（P＜0．05）;靶区最大剂量Dmax分别为（6658．26±215．29）cGy、（6664．20±465．16）cGy,差异没有统计学意义（P＞0．05）;靶区最小剂量Dmin分别为（5458．88±184．06）cGy、（4541．60±599．0）cGy,差异有统计学意义（P＜0．05）;靶区平均剂量Dmean分别为（6232．80±53．00）cGy、（6105．78±163．34） cGy,差异有统计学意义（P＜0．05）;CI值分别为（0．76±0．04）、（0．57±0．05）,差异有统计学意义（P＜0．05）;HI值分别为1．07±0．02、1．12±0．06,差异有统计学意义（P ＜0．05）;脊髓最大剂量分别为（3889．68±712．69）cGy、（4337．48±178．49）cGy,差异有统计学意义（P＜0．05）;双肺V20分别为（20．94±5．32）％、（21．90±6．94）％,差异没有统计学意义（P＞0．05）;双肺V10分别为（35．39±11．41）％、（29．0±8．80）％,差异有统计学意义（P＜0．05）,双肺V5分别为（44．95±15．55）％、（37．27±11．93）％,差异有统计学意义（ P＜0．05）。结论调强放疗在胸上段食管癌治疗中显示出95％等剂量线所包括的PTV体积、靶区适形度及靶区内平均剂量、脊髓保护方面均优于3D-CRT技术;但是双肺低剂量照射区域有所增加,肺损伤的风险就有可能增大。     

肺癌患者外周血及胸腔积液调节性T细胞的表达及其临床意义

目的探讨肺癌患者胸腔积液及外周血CD＋4CD＋25调节T细胞、T细胞亚群的特点及其临床意义。方法采用流式细胞术检测68例肺癌患者外周血和其中32例并发胸腔积液患者的胸腔积液及56名健康对照者外周血中CD＋4CD＋25T细胞和淋巴细胞亚群的水平。结果不同TNM分期肺癌患者外周血T淋巴细胞亚群表达比例不同,其中Ⅰ＋Ⅱ、Ⅲ、Ⅳ期患者外周血CDIcD击细胞占cD刍细胞比例分别为（19．52±3．32）％、（27．28±8．26）％、（32．31±15．60）％,均高于健康对照组的（11．12±3．32）％,差异均有统计学意义（t=31．0040、-7．9688、-4．9770,均P〈005）。合并胸腔积液患者胸腔积液CDICD嘉细胞占CD＋34细胞比例为（34．12±18．63）％,高于其外周血的（26．36±16．25）％,差异有统计学意义（t=21．164,P〈0．05）;合并胸腔积液肺癌患者胸腔积液及外周血CD＋4细胞比例分别为（25．32±13．45）％及（34．68±12．34）％,低于健康对照组的（43．24±8．68）％（t=7．3104、4．8818,均P〈0．05）,CD＋56细胞比例分别为（8．24±7．38）％及（11．23±7．65）％,低于健康对照组的（18．23±9．23）％（t=-14．7549、-11．7216,均P〈0．05）,CD＋4／CD＋8分别为（1．02±0．56）％及（1．32±0．82）％,低于健康对照组的（1．89±0．32）％,差异均有统计学意义（CD＋4／CD＋8;t=-24．78、-4．4564,均19〈0．05）。结论肺癌患者胸腔积液及外周血CD＋4CD＋25T细胞水平升高,与肿瘤患者免疫功能低下及肿瘤的发生、发展密切相关。     

治疗前后口腔颌面肿瘤患者血小板和血管内皮生长因子水平比较

目的 比较治疗前后口腔颌面肿瘤患者血小板和血管内皮生长因子(VEGF)水平.方法 选择80例口腔颌面肿瘤患者为研究对象,其中良性肿瘤65例,恶性肿瘤15例.分析比较良性和恶性口腔颌面恶性肿瘤患者治疗前后的血小板和血管内皮生长因子水平.结果 治疗前后恶性肿瘤患者的血小板计数(PLT)、血小板容积比(PCT)和血小板平均体积(MPV)均明显高于良性肿瘤患者(P<0.05),治疗前后2种性质肿瘤患者的血小板分布宽度(PDW)差异均无统计学意义(P>0.05).良、恶性肿瘤患者治疗后的PLT、PCT和MPV均明显低于治疗前(P<0.05),PDW与治疗前差异无统计学意义(P>0.05).治疗前后恶性肿瘤患者的VEGF水平明显高于良性肿瘤患者(P<0.05),良恶性肿瘤患者治疗后的VEGF水平均明显低于治疗前(P<0.05).结论 血小板尤其是PLT、PCT和MPV参数以及VEGF水平可为口腔颌面肿瘤及其性质的诊断提供一定的参考,同时也可为判断口腔颌面肿瘤治疗时机提供部分依据.但血小板和VEGF对口腔颌面肿瘤的作用机制需进一步研究.     

Evaluation of Platelet Indices in Lung Cancer Patients

Background: In this study, we aimed to determine platelet indices such as platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), Plateletcrit (PCT) platelet count (PLT) in lung cancer cases, and evaluate any relationships between these parameters and stage or histologic types. Materials and Methods: This retrospective study covered 44 lung cancer patients and 47 healthy subjects. Platelet indices including PLT, PCT, MPV, PDW were estimated and compared with normal subjects. The results were evaluated statistically. Results: The PDW value was significantly higher in the cancer group compared to the control group; however, the values for PCT and MPV were lower. Conclusions: We suggest potential use of platelet indices in diagnosis of lung cancer.     

Platelet Indices May be Useful in Discrimination of Benign and Malign Endometrial Lesions,and Early and Advanced Stage Endometrial Cancer

Background: The aim of this study was to investigate the predictive value of white blood cells (WBC),the neutrophil to lymphocyte ratio (NLR), platelet indices including mean platelet volume (MPV), plateletdistribution width (PDW), platelet crit (PCT) and platelet to lymphocyte ratio (PLR) in discrimination betweenbenign and malign endometrial lesions, and early and advanced stage endometrial adenocarcinomas. Materialsand Methods: Data for 105 patients undergoing total abdominal or vaginal hysterectomy for benign uterinediseases and 114 patients surgically staged for endometrium adenocarcinoma at Ondokuz Mayis University,Department of Gynecology and Obstetrics, between 2008 and 2014, were collected. Parameters were preoperativeand postoperative complete blood counts in the week prior to surgery with differentials including WBC, plateletcount, platelet indices (MPV, PCT, PDW), NLR and PLR. Pathologic evaluations for both benign and malignendometrium lesions, grade of endometrium adenocarcinoma, tumor stage, presence of lymphovascular spaceinvasion (LVI) were retrospectively analyzed. Results: Regarding definitive factors in discriminating patientswith endometrium cancer from those with benign diseases, MPV was significantly increased in the malign groupwhereas there was a significant decrease in the PDW value compared to the benign group. The best cut-off valuein differentiation of the benign and malign groups, malign cases were found to increase over the value of 7.54for MPV, and under 37.8 for PDW. When definitive factors in discrimination of early stage endometrium cancerfrom advanced stage disease and LVI in the malign group were evaluated according to the ROC analysis, nosignificant relation was detected between blood parameters and the stage and the LVI of the disease. Conclusions:MPV and PDW may have predictive value in the discrimination of benign and malign endometrium diseases.Nevertheless, since there have been few reports on this topic, further large-scale prospective studies are necessary.     

Mean Platelet Volume and Platelet Distribution Width Are Associated with Gallbladder Cancer

Gallbladder cancer (GBC) represents the most common biliary tract malignancy. Activated platelets play an essentialrole in cancer development and progression. Mean platelet volume (MPV) and platelet distribution width (PDW) arecommonly used indexes of activated platelets in clinical practice. The aim of the current study was to investigate theassociation of MPV and PDW with GBC. 104 GBC patients and 109 normal control subjects were entered in thisstudy between January 2015 and December 2015. We collected all participants’ clinical and laboratory characteristicsat initial diagnosis. The odds ratios (ORs) for GBC were calculated using multivariate logistic regression analysis afteradjusting for confounding variables across MPV and PDW quartiles. MPV levels were markedly lower and PDW levelswere remarkably higher in GBC patients than control subjects. A significant correlation between PDW and lymph nodemetastasis was detected. In addition, after adjusting for other risk factors, the ORs (95% CIs) for GBC in each MPVquartile were 5.117 (1.939-13.506), 2.444 (0.917-6.516), 3.718 (1.381-10.007), and 1.000, respectively. The ORs (95%CIs) for GBC in each PDW quartile were 1.000, 2.063 (0.825-5.162), 3.070 (1.108-8.507), and 12.108 (4.243-34.553),respectively. In conclusion, decreased MPV and elevated PDW were independently associated with GBC. Our findingssuggest that MPV and PDW are available parameters for early detection of GBC.     

Prostate Specific Antigen,Mean Platelet Volume,and Platelet Distribution Width in Combination to Discriminate Prostate Cancer from Benign Prostate Hyperplasia

Background: Prostate cancer (PCa) represents the second most commonly diagnosed malignancy and the sixthleading cause for cancer related death among men worldwide. Although use of the prostate specific antigen (PSA) asa diagnostic marker has improved the detection and management of PCa, low specificity and sensitivity has limited itsclinical efficacy. Moreover, elevated PSA is frequently observed in benign prostate hyperplasia (BPH). Mean plateletvolume (MPV) and platelet distribution width (PDW) are commonly used indicators of platelet activation. The purposeof current study was to investigate the ability of PSA, MPV, and PDW individually or in combination, to differentiatePCa from BPH. Materials and Methods: This study included 100 patients with PCa and 108 patients with BPH. Wecollected all participants’ clinical and laboratory characteristics. The benefit of adding MPV and PDW to a modelwith only PSA was evaluated as an increased in the area under the curve (AUC) obtained by receiver operating curve(ROC). Results: PCa patients had reduced MPV and elevated PSA and PDW levels compared to BPH patients. Singlebiomarkers had AUC values ranging from 0.683 for PDW to 0.865 for PSA. Moreover, the combination of PSA, MPV,and PDW increased the AUC to 0.935 (0.892-0.964) (p<0.0001), significantly higher than those of any single marker.Conclusions: The combined use of PSA, MPV, and PDW may be clinically useful in distinguishing between PCa andBPH.     

肿瘤患者合并深静脉血栓的临床分析

目的:探讨恶性肿瘤并发血栓性疾病的危险因素,为及早预防提供依据.方法:收集30例恶性肿瘤并发血栓栓塞患者为病例组,并收集同期不伴有血栓栓塞的38例恶性肿瘤患者为对照组,回顾性分析恶性肿瘤并发血栓栓塞的危险因素.结果:病例组30例患者中,下肢深静脉血栓形成者24例,上肢深静脉血栓5例,肺栓塞者1例.观察组红细胞计数和血红蛋白值均低于对照组,血小板计数和D-二聚体高于对照组,差异均有统计学意义(P<0.05).恶性肿瘤并发血栓性疾病的发生在并发感染、接受手术、地塞米松治疗和中心静脉置管上存在差异(P<0.05).30例患者在肿瘤确诊2个月内并发血栓性疾病.结论:恶性肿瘤并发感染、地塞米松的应用、接受手术和中心静脉置管的应用时易并发血栓形成.     

Mean Platelet Volume: Is It a Predictive Parameter in The Diagnosis of Sudden Sensorineural Hearing Loss?

The mean platelet volume (MPV) is associated with increased platelet reactivity and increased atherothrombosis. High MPV values are a risk factor for thrombotic vascular diseases. Our aim was to investigate whether a relationship exists between sudden sensorineural hearing loss (SSHL) and a high MPV value. The records of 46 patients who were admitted to the ENT (ear nose throat) ward for SSHL and received medical treatment and 46 patients in a control group were retrospectively screened. The correlation among the levels of the MPV, the number of platelets, and SSHL were evaluated in the two groups. The ages, genders, and the platelet count values of the patients showed a normal distribution in both groups. No significant difference was found for the MPV values between the groups. The MPV is not a predictive parameter in the diagnosis of SSHL.     

恶性肿瘤,高血压病患者及健康人血液流变学观察

目的　探讨恶性肿瘤与血液流变学的关系。方法　对恶性肿瘤患者４４ 例与高血压病患者４２ 例及健康人４２例的血液流变学进行观察分析。结果　恶性肿瘤患者的红细胞沉降率、血浆粘度、血栓长度、血小板粘附率均高于高血压组及正常组（Ｐ＜ ０．０５ 和Ｐ＜ ０．０１）;红细胞压积低于高血压组及正常对照组（Ｐ＜ ０．０１）;血栓湿重明显高于正常组（Ｐ＜ ０．０１）;全血高切粘度平均值低于高血压组（Ｐ＜ ０．０５）,有显著性差异,晚期转移组的红细胞沉降率,血浆粘度高于非转移组（Ｐ＜ ０．０５）;血球压积低于非转移组（Ｐ＜ ０．０１）。结论　恶性肿瘤患者存在着明显的血液流变学异常,晚期患者尤其明显,提示恶性肿瘤患者处于高粘高凝状态,检测血液流变学对判断病情预测预后有一定意义,改善血液粘滞状态可以延缓病情,防止转移,预防血栓并发症发生。     

Relations of Platelet Indices with Endometrial Hyperplasia and Endometrial Cancer

Background: Platelets are blood elements thought to play a role in the immune system and therefore tumordevelopment and metastasis. Platelet activation parameters such as mean platelet volume (MPV), plateletdistribution width (PDW), and plateletcrit (PCT) can be easily evaluated with the whole blood count and havebeen studied as markers of systemic inflammatory responses in various cancer types. Our aim in this study wasto evaluate the correlation between endometrial pathologies and MPV, PDW and PCT. Materials and Methods:A total of 194 patients who presented to our clinic with abnormal vaginal bleeding were included in our study.The patients were divided into 3 groups (endometrial hyperplasia, endometrial cancer, control) according to theirpathology results. The groups were compared for MPV, PDW, and PCT values obtained from the blood samplestaken on endometrial biopsy day. Results: The endometrial cancer patients were the oldest group (p=0.04).There was no significant difference between the three groups in terms of white blood cell count (WBC), plateletcount (PC), and hemoglobin (Hb) level. The highest MPV (p<0.001), PDW (p=0.002), and PCT (p<0.001) levelswere in the endometrial cancer group, and the lowest levels were in the control group. Conclusions: The easyevaluation of platelet parameters in patients who are suspected of having endometrial pathology is a significantadvantage. We found MPV, PDW, and PCT to be correlated with the severity of endometrial pathology with thehighest values in endometrial cancer. Studies to be conducted together with different laboratory parameters willfurther help evaluate the diagnosis and severity of endometrial cancer and precursor lesions.