脑胶质瘤手术前后凝血及纤溶指标的变化及其临床意义

目的 探讨脑胶质瘤病人手术前后凝血及纤溶指标变化及其临床意义。方法 选取2017年2月至2018年2月收治的脑胶质瘤120例，其中高级别60例（高级别组），低级别60例（低级别组），另选60例健康体检者为对照组。术前、术后1 d检测凝血与纤溶指标、血小板计数。结果 术前，高级别组与低级别组活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、血小板计数小于对照组（P<0.05），高级别组明显低于低级别组（P<0.05）；高级别组与低级别组D-二聚体（D-D）、纤维蛋白降解产物（FDP）高于对照组（P<0.05），高级别组明显高于低级别组（P<0.05），高级别组纤维蛋白原（Fig）明显高于低级别组与对照组（P<0.05）。术后1 d，高级别组、低级别组APTT、PT、血小板计数明显小于术前（P<0.05）。APTT与胶质瘤分级呈明显负相关（r=-0.586；P<0.05），D-D、FDP、Fig与胶质瘤分级呈明显正相关（r分别为0.692、0.813、0.524；P<0.05）。结论 脑胶质瘤存在凝血-纤溶系统障碍，手术可加重高凝血状态，APTT、D-D、FDP、Fig与胶质瘤分级关系密切。

Changes in perioperative coagulation and fibrolysis indexes in patients with brain gliomas and their clinical meanings

Objective To observe the changes in the perioperative coagulation and fibrinolysis indexes in the patients with brain gliomas and their meanings. Methods The coagulation and fibrinolysis indexes including thrombin time (TT), activated partial thromboplasin time (aPTT) fibrinogen (Fbg), prothrombin time (PT), D-dimer (D-D), fibrinogen degradation product (FDP) and blood platelet count (BPC) were detected 1 day before and after the operation respectively in 60 patients with WHO grades Ⅰ~Ⅱ brain gliomas, 60 patients with WHO grades Ⅲ~Ⅳ and 60 healthful subjects. The relationships among the above-mentioned indexes were analyzed. Results The aPTT, PT and BPC were significantly lower in the patients with WHO grades Ⅲ~Ⅳ than those in the patients with WHO gradesⅠ~Ⅱ (P<0.05), which were significantly lower than those in the healthful subjects before the operation (P<0.05). The blood levels of D-D and FDP were significantly higher in the patients with WHO grades Ⅲ-Ⅳ than those in the patients with WHO grades Ⅰ~Ⅱ, which were significantly higher than those in the healthful subjects before the operation (P<0.05).The blood level of Fbg was significantly higher in the patients with WHO Ⅲ~Ⅳ than those in the patients with WHO grades with Ⅰ~Ⅱ and healthful subjects (P<0.05) and there was insignificant difference in the blood level of Fbg between the patients with WHO grades Ⅰ~Ⅱ and healthful subjects before the operation (P>0.05). The aPTT, PT and BPC were significantly lower after the operation than those before the operation in all the patients with gliomas (P<0.05) and the blood levels of D-D, FDP and Fbg were significant higher after the operation than those before the surgery in all the patients with glimoas(P<0.05). The aPTT was negatively correlated with glioma WHO grade (P<0.05), while the blood levels of D-D, FDP and Fbg were positively correlated with glioma WHO grade (P<0.05). Conclusions There is abnormal coagulation-fibrinolysis system and its abnormality is worse after the operation than that before the operation in the patients with brain gliomas. The aPTT, D-D, FDP and Fbg are significantly correlated with glioma WHO grade.