肿瘤患者治疗过程中血栓的实验室预警及预防  

Early laboratory detection and prevention of thrombosis during treatment of cancer patients

作　　者：郭瑛 刘玉娟 魏葆珺[2] 张育荣 GUO Ying;LIU Yu-juan;WEI Bao-jun;ZHANG Yu-rong(Beijing Chaoyang District Sanhuan Cancer Hospital,Beijing 100122,China;不详)

机构地区：[1]北京市朝阳区三环肿瘤医院检验科,北京100122 [2]中国医学科学院肿瘤医院检验科

出　　处：《慢性病学杂志》2022年第11期1673-1677,共5页Chronic Pathematology Journal

摘　　要：目的探讨肿瘤患者治疗中血栓发生的实验室预警指标及预防作用。方法分析北京市朝阳区三环肿瘤医院2021年2-11月240例肿瘤患者的临床资料,经血管超声分为血栓组和无栓组,比较两组实验室指标[血栓最大振幅(maximum amplitude,MA)、D-二聚体(D-dimmer,DD)、血小板(platelet,PLT)、血管内皮生长因子(vascular endothelial growth factor,VEGF)]差异及指标诊断效能,并确定指标最佳截点。进一步选择2021年12月-2022年4月171例肿瘤患者,上述4项实验室指标(MA、DD、PLT、VEGF)高于截点,采用随机数字表法分为用小分子肝素干预组(58例)和非干预组(113例),观察从入院到治疗4疗程结束两组血栓发生情况。结果血栓组肿瘤患者MA、DD、PLT和VEGF水平均高于无栓组,差异有统计学意义(P<0.05)。MA-DD-PLT-VEGF联合检测受试者工作特征曲线下面积为0.908,敏感度为0.839,特异度为0.714。小分子肝素干预组干预后MA、DD、VEGF水平较干预前明显降低,差异有统计学意义(P<0.05),PLT干预前后差异无统计学意义(P>0.05)。干预组血栓发生率为13.78%,显著低于未干预组的血栓发生率(27.43%),干预组中位血栓发生时间为63 d,也较未干预组中位血栓发生时间(47 d)延长,差异有统计学意义(P<0.05)。结论MA-PLT-DD-VEGF联合检测可对肿瘤患者血栓发生起到预警作用,用小分子肝素进行预防可以降低血栓发生。Objective To determine the early laboratory detection and prevention of thrombosis in cancer patients.Methods The clinical data of 240 cancer patients undergoing treatment at the Beijing Chaoyang Sanhuan Cancer Hospital from February to November 2021 were analyzed.The patients were divided into thrombus and non-thrombus groups based on vascular ultrasound findings.Laboratory indicators[maximum amplitude(MA),D-dimer(DD),platelet(PLT)count,and vascular endothelial growth factor(VEGF)]were compared between the two groups,and the best cumulative cut-off value was determined.A total of 171 cancer patients with the four laboratory indicators(MA,DD,PLT count,and VEGF)greater than the cumulative cut-off value between December 2021 and April 2022 were selected and divided into small molecule heparin intervention(n=58)and non-intervention resistance groups(n=113)using the random number table method.The difference in incidence of thrombosis between the two groups from admission to the end of four treatment cycles verified the early laboratory detection.Results The MA,DD,PLT count,and VEGF levels in the thrombus group patients were higher than those in the non-thrombus group patients;the differences were statistically significant(P<0.05).The cumulative MA-DD-PLT countVEGF cut-off value area under the receiver-operating characteristic curve was 0.908,the sensitivity was0.839,and the specificity was 0.714.The levels of MA,DD,and VEGF in the small molecule heparin intervention group were significantly decreased after intervention(P<0.05),while there was no statistical significance before and after the intervention with respect to the PLT count(P>0.05).The incidence of thrombosis in the intervention group was 13.78%and the median time-to-thrombosis was 63 days,which was significantly lower than the non-intervention group(27.43%).The time-to-thrombosis was also longer than the non-intervention group(median time of thrombosis,47 days);the difference was statistically significant(P<0.05).Conclusion The MA-PLT count-DD-VEGF cumulati

关 键 词：肿瘤 静脉血栓 早期预警 预防 

分 类 号：R730.5[医药卫生—肿瘤]