同步放化疗治疗进展期实体恶性肿瘤对凝血指标的影响

目的:观察进展期实体恶性肿瘤患者同步放化疗期间凝血功能指标的动态变化，寻找敏感的凝血功能监测指标。方法:选取2016年11月至2018年3月于我科住院行同步放化疗且治疗有效的Ⅲ－Ⅳ期实体恶性肿瘤患者共93例，对比放化疗前、中、后凝血标志物:凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原浓度（FIB）、D－二聚体（D-D）和血栓前体蛋白（TpP）的数值变化。结果:治疗前33.3%（31/93）的患者D-D升高，72.0%（67/93）的患者TpP升高，D-D与TpP呈线性相关（P=0.00）。治疗前、中、后D-D值［（1.22±1.43），（1.28±1.13），（1.59±1.46） mg/L］和TpP值［（5.89±3.55），（7.18±3.71），（8.33±4.22） mg/L］均呈逐步上升趋势（治疗前、后对比P＜0.05），而PT、APTT、FIB无显著变化(P＞0.05)。亚组分析显示治疗前D-D升高的31例患者群疗程中D-D值［（2.75±1.61），（1.72±0.99），（2.53±1.71） mg/L］先下降（治疗前、中对比P＜0.05），后再升高（治疗中、后对比P＜0.05）。结论:（局部）晚期实体恶性肿瘤治疗前常伴有凝血功能异常，表现为D-D、TpP升高，同步放化疗引起D-D、TpP进一步动态升高，治疗期间应重点监测该指标，及时抗凝干预以降低静脉血栓风险。

The influence of radio-chemotherapy on coagulation parameters in patients with advanced solid malignant tumors

Objective:To find out sensitive coagulation function monitoring parameters through observing the dynamic changes of coagulation parameters during radio-chemotherapy in patients with (local) advanced malignant tumors.Methods:A total of 93 patients with stage Ⅲ-Ⅳ solid malignant tumor who received radio-chemotherapy with tumor regression in our hospital in the period between 11/2016 to 3/2018 were selected.Coagulation parameters such as PT (prothrombin time),APTT (activated partial thromboplastin time),FIB (fibrinogen),D dimer and TpP (thrombus precursor protein) before,in and after treatment were recorded and analyzed.Results:Pretreatment abnormality of D dimer and TpP existed in 33.3%（31/93） and 72%（67/93） of all the patients respectively.D dimer and TpP was correlated to each other significantly(P=0.00).D dimer ［(1.22±1.43）,（1.28±1.13）,（1.59±1.46） mg/L］ and TpP［(5.89±3.55）,（7.18±3.71）,（8.33±4.22） mg/L］ increased gradually as treatment begins (P＜0.05).While no significant changes in PT,APTT and FIB were found during treatment (P＞0.05).In subgroup analysis,D dimer ［(2.75±1.61）,（1.72±0.99）,（2.53±1.71） mg/L］ firstly decreased significantly(P＜0.05) and then raised obviously again after treatment in the group of 31 patients with pretreatment abnormal D dimer.Conclusion:Coagulation function abnormality can be found frequently in solid malignant tumors which is featured with elevated D dimer and TpP.Radio-chemotherapy further aggravated the abnormality of D dimer and TpP,inducing hypercoaglutabe state.D dimer and TpP are sensitive indicators for anticoagulant intervention aiming to prevent thromobgenesis during radio-chemotherapy.