肺癌患者血管内皮、凝血与纤溶系统分子标志物检测及临床意义

摘要：目的：观察血浆血栓调节蛋白（TM）、凝血酶-抗凝血酶复合物（TAT）、组织型纤溶酶原激活物-纤溶酶原激活物抑制剂复合物（t-PAIC）、纤溶酶-α₂纤溶酶抑制剂复合物（PIC）4项指标与肺癌病情发展及手术疗效的关系。 方法：采用化学发光酶免疫法测定山东大学第二医院2016年9月至2017年12月158例肺癌患者［非小细胞肺癌（NSCLC）患者113例，小细胞肺癌（SCLC）患者45例］、53例肺良性疾病患者及60例健康对照者血浆TAT、TM、t-PAIC、PIC水平，分别比较肺癌组、肺良性疾病组与健康人对照组，肺癌组有或无转移组，以及肺癌患者手术前后组上述4项指标的差异。 结果：肺癌组血浆TAT、TM、t-PAIC、PIC水平均高于肺良性疾病组和健康人对照组（P均＜0.01），但肺良性疾病组与健康人对照组比较差异均无统计学意义（P均＞0.05）；肺癌转移组血浆TAT、TM、t-PAIC、PIC水平均高于无转移组（P均＜0.01或P均＜0.05），其中SCLC组有或无转移组血浆t-PAIC水平差异未见统计学意义（P＞0.05）；肺癌手术后7～10 d血浆TAT、TM、t-PAIC、PIC水平均较术前下降，差异均有统计学意义（P均＜0.001）。 结论：肺癌患者血浆TAT、TM、t-PAIC、PIC水平升高，4项血栓分子标志物可能与肺癌病情进展有关。

Detection of plasma vascular epithelial injury and coagulation-fibrinolytic system markers in lung cancer patients and its clinical values

Objective To explore the relationship of plasma thrombomodulin(TM),thrombin-antithrombin complex(TAT),plasmin-alpha 2 plasmin inhibitor complex(PIC) and tissue plasminogen activator-plasminogen activator inhibitor-1 complex(t-PAI-C) with lung tumors. Methods The levels of plasma TM,TAT,PIC and t-PAI-C were determined by chemiluminescence enzyme immunoassay in 158 lung cancer patients(113 cases of NSCLC patients and 45 cases of SCLC patients),53 with benign lung diseases (benign control group) and 60 healthy subjects(healthy control group). The difference of plasma TM,TAT,PIC and t-PAI-C between lung cancer group,benign control group and healthy control groups was evaluated,and the difference between tumor metastasis and non-tumor metastasis groups,and before and after surgery for lung cancer were analyzed as well. Results The levels of TM,TAT,PIC and t-PAI-C in lung cancer group were higher than those in benign control group and healthy control group(P<0.01). while the difference of the markers level between benign and healthy control group has no significance (P>0.05). The levels of TM,TAT,PIC and t-PAI-C in SCLC lung cancer group were higher than those in two control group(P<0.01). There was also statistical significance for TM,TAT,PIC and t-PAI-C between NSCLC lung cancer group and healthy control group(P<0.01). In lung cancer tumor group,TM,TAT,PIC and t-PAI-C were higher in tumor metastasis group than those in non-tumor metastasis group(P<0.01 or P<0.05),while there was no statistical difference between two groups for t-PAI-C in SCLC patients(P>0.05). The levels of TAT,TM,PIC and t-PAI-C after lung cancer surgery were significantly lower than those before surgery(P<0.001). Conclusions Malignant lung tumor patients have different degrees of vascular epithelial injury and coagulation-fibrinolytic system disorder. Plasma TM,TAT,PIC and t-PAI-C are valuable biologic markers of lung cancer for early-stage thrombosis diagnosis,also can be used as indicators for lung cancer progression,curative effect and prognosis.