不同分期肺癌患者术后下肢深静脉血栓形成发生率及凝血指标水平比较

目的探讨不同分期肺癌患者术后下肢深静脉血栓形成(deep vein thrombosis,DVT)发生情况及凝血指标水平变化。方法肺癌患者289例,其中国际抗癌联盟Ⅰ期及原位癌85例(Ⅰ期组),Ⅱ期145例(Ⅱ期组),Ⅲ期59例(Ⅲ期组),均行根治性切除术。3组术后7 d内均行下肢深静脉彩超检查,记录DVT发生率;分别于术前及术后7 d采集静脉血,检测血小板计数、纤维蛋白原、凝血酶原时间(prothrombin time,PT)、D-二聚体(D-dimer,DD)水平。结果289例术后发生DVT 21例,发生率为7.27%;Ⅲ期组DVT发生率(16.95%)高于Ⅰ期组(1.18%)、Ⅱ期组(6.90%),且Ⅱ期组高于Ⅰ期组(P<0.05);Ⅰ、Ⅱ、Ⅲ期组术后7 d血小板计数(224.8±11.7)×10^9/L、(214.5±10.6)×10^9/L、(224.8±12.2)×10^9/L]、纤维蛋白原(4.0±1.2)、(3.7±1.5)、(4.1±1.3)g/L]、PT(11.9±3.2)、(10.5±1.1)、(11.0±1.6)s]与术前血小板计数:(211.4±8.7)×10^9/L、(204.5±9.5)×10^9/L、(221.1±10.2)×10^9/L;纤维蛋白原:(3.8±1.0)、(3.5±1.1)、(3.6±1.2)g/L;PT:(11.8±2.1)、(10.8±1.6)、(10.7±1.5)s]比较差异无统计学意义(P>0.05),且3组组间术前、术后7 d比较差异均无统计学意义(P>0.05);Ⅰ、Ⅱ、Ⅲ期组术前血清D-D(0.5±0.4)、(0.5±0.3)、(0.5±0.1)g/L]比较差异无统计学意义(P>0.05),术后7 d(1.2±0.1)、(2.8±0.2)、(4.5±0.6)g/L]均高于术前(P<0.05),且术后7 dⅢ期组高于Ⅰ、Ⅱ期组(P<0.05),Ⅰ期组与Ⅱ期组比较差异无统计学意义(P>0.05)。结论肺癌患者UICC分期越高,术后DVT发生率越高,检测血清D-D水平有助于评估肺癌患者术后DVT发生风险。

Comparison of the incidence of deep vein thrombosis and coagulation indexes in patients with lung cancer of different stages

Objective To investigate the incidence of deep vein thrombosis(DVT)and the change of coagulation indexes in different stages of lung cancer.Methods Totally 289 lung cancer patients undergoing radical resection included 85 patients with in situ cancer and cancer in Union for International Cancer Control(UICC)stageⅠ(stageⅠgroup),145 patients in UICC stageⅡ(stageⅡgroup)and 59 patients in UICC stageⅢ(stageⅢgroup).All patients received lower extremity deep vein color Doppler ultrasonography on the 7 th postoperative day to record the incidence of DVT.Before and on the 7 th postoperative day,the platelet count,fibrinogen,prothrombin time(PT)and D-dimer(D-D)levels were detected.Results In 289 patients,21(7.27%)were found DVT on the 7 th postoperative day.The incidence of DVT was higher in stageⅢgroup(16.95%)than that in stageⅠgroup(1.18%)and stageⅡgroup(6.90%)(P<0.05),and higher in stageⅡgroup than that in stageⅠgroup(P<0.05).The levels of platelet count((224.8±11.7)×10^9/L,(214.5±10.6)×10^9/L,(224.8±12.2)×10^9/L),fibrinogen((4.0±1.2),(3.7±1.5),(4.1±1.3)g/L),and PT((11.9±3.2),(10.5±1.1),(11.0±1.6)s)in stageⅠ,ⅡandⅢgroups on the 7 th postoperative day showed no significant differences from those before operation((211.4±8.7)×10^9/L,(204.5±9.5)×109/L,(221.1±10.2)×109/L;(3.8±1.0),(3.5±1.1),(3.6±1.2)g/L;(11.8±2.1),(10.8±1.6),(10.7±1.5)s)(P>0.05),and also showed no significant differences among groups both before operation and on the7 th postoperative day(P>0.05).The serum D-D level showed no significant difference among stageⅠ,ⅡandⅢgroups((0.5±0.4),(0.5±0.3),(0.5±0.1)g/L)before operation(P>0.05),lower than those on the 7 th postoperative day((1.2±0.1),(2.8±0.2),(4.5±0.6)g/L)(P<0.05),higher in stageⅢgroup than that in stageⅠandⅡgroups on the 7 th postoperative day(P<0.05),and showed no significant difference between stageⅠandⅡgroups(P>0.05).Conclusion The higher the UICC stage,the higher the risk of DVT.Monitoring the level of serum D-D contributes to the evaluation of the risk for postoperative DVT in patients with stageⅢlung cancer.