肿瘤相关易栓症患者实验室指标的变化及临床意义

目的:探讨活化部分凝血活酶时间（activated partial thromboplastin time，APTT）、凝血酶原时间（prothrombin time，PT）、凝血酶时间（thrombin time，TT）、纤维蛋白原（fibrinogen，FIB）、D-二聚体（D-dimer，D-D)、红细胞（red blood cell，RBC）、血红蛋白（hemoglobin，HGB）、红细胞压积（hematocrit，HCT）、血小板（platelet，PLT）、平均血小板体积（mean platelet volume，MPV）及球蛋白（globulin，GLO）、甘油三酯（triglyceride，TG）、高密度脂蛋白（high density lipoprotein，HDL）在肿瘤相关易栓症患者中的变化及临床意义。方法:病例组136例，分为肿瘤组76例，包括非霍奇金淋巴瘤（non-Hogkin lymphoma，NHL）19例、胃癌（gastric cancer，GC）30例、肺癌（lung cancer，LC）27例。均为初治病例，于化疗后1月纳入统计。非肿瘤-深静脉血栓形成组（non-tumor deep vein thrombosis，NT-DVT）60例，均为确诊的下肢DVT患者，抗凝治疗后2周纳入统计。对照组90例，来自本院门诊健康体检者。经全自动血凝仪、全自动血球仪及全自动生化分析仪检测APTT、PT、TT、FIB、D-D、RBC、HGB、HCT、PLT、MPV及GLO、TG、HDL水平变化。结果:肿瘤组患者化疗前D-D表达水平升高（P＜0.05），化疗后下降（P＜0.05）。肿瘤组患者化疗前HDL表达水平下降（P＜0.05），化疗后升高（P＜0.05）。肿瘤组患者化疗前FIB、PLT、GLO表达水平升高（P＜0.05）。NT-DVT组治疗前APTT、FIB、D-D表达水平升高（P＜0.05），治疗后APTT延长（P＜0.05），FIB、D-D下降（P＜0.05）。结论:D-D、FIB、PLT、GLO、HDL水平是反映肿瘤相关易栓症患者血栓前状态的良好指标。

Changes and clinical significance of laboratory indexes in patients with tumor associated thrombophilia

Objective:To explore changes and their clinical significance of activated partial thromboplastin time(APTT)，prothrombin time(PT)，thrombin time(TT)，fibrinogen(FIB)，D-dimer(D-D)，red blood cell(RBC)，hemoglobin(HGB)，hematocrit(HCT)，platelet(PLT)，mean platelet volume(MPV)，globulin(GLO)，triglyceride(TG) and high density lipoprotein(HDL) in patients with tumor associated thrombophilia.Methods:136 patients were divided into tumor group and NT-DVT group.Tumor group included 19 non-Hogkin lymphoma，30 gastric cancer，27 lung cancer.The samples that are all previously untreated were collected 1 month after chemotherapy.NT-DVT group had 60 patients who were already diagnosed with DVT of lower extremity.The samples were collected 2 weeks after anticoagulant therapy.The control group was composed of 90 healthy cases from outpatient.Automatic coagulation analyzer，automatic hematology analyzer and automatic biochemistry analyzer were used to detect the level changes of APTT，PT，TT，FIB，D-D，RBC，HGB，HCT，PLT，MPV，GLO，TG and HDL.Result:The expression level of D-D in tumor group was higher than control group before chemotherapy and decreased after chemotherapy（P＜0.05）.The expression level of plasma HDL in tumor group was lower than control group before chemotherapy and increased after chemotherapy（P＜0.05）.The expression level of plasma FIB,PLT and GLO in tumor group were higher than control group before chemotherapy（P＜0.05）.The expression level of plasma APTT,FIB and D-D in NT-DVT group were higher than control group before treatment.After treatment，the level of APTT increased（P＜0.05），but the level of FIB and D-D decreased（P＜0.05）.Conclusion:D-D，FIB，PLT，GLO and HDL are good markers in reflecting the pre-thrombosis status of patients with tumor associated thrombophilia.