胃肠道恶性肿瘤患者凝血功能的研究  

The Study of Heamostatic Function in Patients with Gastrointestinal Cancer

作　　者：叶为德[1] 邹丽芳[1] 姚一芸[1] 窦红菊[1] 朱琦[1] 胡钧培[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院血液科,上海200011

出　　处：《血栓与止血学》2015年第4期222-224,共3页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的观察胃肠道恶性肿瘤患者在有无肿瘤复发转移不同时期的止凝血功能的变化,以探索其在胃肠道恶性肿瘤患者中的诊断、预后判断中的意义。方法对48例胃肠道恶性肿瘤患者止凝血功能进行检测,并对36例正常对照组人群进行比较。检测项目包括PLT、PT、aP TT、TT、Fbg、D-D等常规止凝血指标,及GMP-140、TF、AT、TAT、PAP、tP A、PAI-1等反映血小板活化、凝血、抗凝血和纤溶指标的分子标志物指标。结果在胃肠道恶性肿瘤患者中均有Fbg和D-D的升高(P<0.05),但在疾病复发转移组中升高更加明显(P<0.01),同时在复发转移组中又出现了PT、aP TT的缩短(P<0.05);在胃肠道恶性肿瘤组中均存在着GMP-140、TF、和TAT的升高(P<0.05)、且在肿瘤复发转移组中升高得更明显(P<0.05或P<0.01),同时在这组患者中又有AT活性的降低(P<0.05);在胃肠道恶性肿瘤组中存在着纤溶指标PAP和tP A含量的升高(P<0.05),在肿瘤复发转移组中这些指标升高得更明显(P<0.05或P<0.01),而在这组患者中又出现了纤溶酶原抑制物PAI-1含量的升高(P<0.05)。结论胃肠道恶性肿瘤患者体内同时存在着血小板活化、凝血激活、抗凝血抑制和纤溶系统的常规止凝血指标和分子标志物指标的改变。这些改变可作为胃肠道恶性肿瘤的预测、肿瘤复发转移以及判断预后的参考。Objective s To investigate the haemostatic changes of patients with gastrointestinal cancer at the different stages,such as disease in relapse or metastasis. Methods Routine haemostatic tests were conducted among 48 patients with gastrointestinal cancer. 36 healthy volunteers were enrolled as controls. The tests included the plasma concentration of PLT,PT,aPTT,TT,Fbg,D-dimer. Some coagulable and fibrinolytic molecular markers,such as GMP-140,TF,TAT,PAP,tPA,PAI-1 were also measured. Results The plasma concentrations of Fbg and Ddimer were elevated in gastrointestinal cancer patients （ P 〈 0.05 ） , while in relapse and metastasis groups, the levels were significantly higher than that of the control （P 〈 0.01 ） , At the same time, PT and aT were shortened（ P 〈 0.05 ）. The plasma levels of GMP-140 ,TF and TAT were elevated in gastrointestinal cancer patients （ P 〈 0.05 ）. Meanwhile, the levels significantly higher than that of the control（P 〈0.05 or P 〈0.01 ）in the relapse and metastasis groups,Decreased activity of AT also took place at the same time（P 〈 0.05 ）. Compared with the normal control, the patients with gastrointestinal cancer had higher concentrations of fibrinolytic parameters, such as PAP and tPA （P 〈 0.05 ）. While in the relapse and metastasis, all these parameters raised more remarkably（ P 〈 0.05 or P 〈 0.01 ）. Furthermore, the concentration of fibrinogen inhibitor PAI- 1 was also elevated （ P 〈 0.05 ）. Conclusion Patients with gastrointestinal cancer may harbor platelet aggregation, activation of coagulation cascade, decreased synthesis of anticoagulant proteins and abnormal activation of fibrinolysis. These markers plays an important role in predicting the relapse and metastasis of the disease.

关 键 词：胃肠道恶性肿瘤 复发转移 常规止凝血功能 

分 类 号：R735[医药卫生—肿瘤]