血栓标志物对恶性肿瘤患者发生静脉血栓的风险评估效果  

Value of thrombotic biomarkers in estimation of venous thromboembolism risk of cancer patients

作　　者：赵小军[1] 魏娟[1] 王建云[1] 

机构地区：[1]西安医学院第二附属医院检验科,陕西西安710038

出　　处：《中国现代医学杂志》2015年第36期58-63,共6页China Journal of Modern Medicine

摘　　要：目的探讨血栓标志物对恶性肿瘤患者发生静脉血栓的风险评估效果。方法选取2013年1月-2014年12月该院新确诊的491例恶性肿瘤患者为研究对象,以3个月内是否发生静脉血栓栓塞症(VTE)分为VTE组(29例)和非VTE组(462例),比较两组患者、不同临床分期患者、不同静脉血栓风险分层患者的血浆D-二聚体(D-D)水平、凝血因子Ⅷ活性(FⅧ:A)、凝血因子Ⅸ活性(FⅨ:A)、血管性血友病因子抗原含量(v WF:Ag)、血栓前体蛋白(Tp P)、抗凝血酶活性(AT:A)、蛋白C活性(PC:A)、蛋白S活性(PS:A)。采用受试者工作特征(ROC)曲线及Logistic多因素回归分析各血栓标志物水平对患者发生VTE的预测效果。结果 VTE组的D-D、FⅧ:A、v WF:Ag、Tp P显著高于非VTE组,而AT:A、PC:A、PS:A显著低于非VTE组(P<0.05),且随着临床分期和静脉血栓风险层级的增高,该现象更加严重。D-D的ROC曲线下面积最大,为0.918,最佳阳性阈值是1 501.6 ng/ml,此时敏感性、特异性、Youden指数分别是0.966、0.773和0.738。Logistic多因素回归分析结果表明手术、化疗、静脉血栓风险评估和D-D水平是患者发生VTE的独立危险因素(P<0.05)。结论除了D-D以外的其他血栓标志物对恶性肿瘤患者发生静脉血栓的风险评估效果不甚理想,恶性肿瘤患者血浆D-D水平明显升高,且与恶性肿瘤的分期和血栓风险分层相关,对患者初诊3个月内的VTE风险的预测价值很高,值得临床推广应用。【Objective】 To investigate the value of thrombotic biomarkers in estimation of venous thromboembolism（VTE） risk on cancer patients. 【Methods】 Totally 491 cancer patients who were confirmed from Jan. 2013 to Dec. 2014 were selected and divided into VTE group（n = 29） and non-VTE group（n = 462）according to the results of 3-month follow-up. The level of D-dimer（D-D）, activities of factor Ⅷ（F Ⅷ： A）,factor Ⅸ（F Ⅸ： A）, von Willebrand factor antigen（v WF： Ag）, thrombus precursor protein（Tp P）, antithrombin（AT： A）, protein C（PC： A） and protein A（PS： A） were compared between the VTE and non-VTE groups,among the patients with different clinical stages or venous thrombosis risk stratifications. Receiver-operating characteristic（ROC） curve and multivariate logistic regression analysis were performed to assess the value of thrombotic biomarkers in estimation of venous thromboembolism risk. 【Results】 D-D, FⅧ： A, v WF： Ag and Tp P in the VTE group were significantly higher than those in the non-VTE group（P 0.05）; and AT： A, PC：A and PS： A were significantly lower than those in the non-VTE group（P 0.05）. The phenomenon was more serious with the increase of clinical stage and venous thrombosis risk levels. Among all biomarkers, the area under the ROC curve of D-D was the biggest（0.918）. Its best positive threshold was 1,501.6 ng/ml, at which the sensitivity, specificity and Youden index were 0.966, 0.773 and 0.738 respectively. Results of multivariate logistic regression analysis showed that surgery, chemotherapy, venous thrombosis risk level and D-D were the independent risk factors affecting VTE in the cancer patients（P 0.05）. 【Conclusions】 Except for D-D, other thrombotic biomarkers are not very ideal for estimation of VTE risk in cancer patients. The plasma D-D level significantly increases in cancer patients, and is correlated to clinical stage and venous thrombosis risk level. It has high predictive value for VTE ri

关 键 词：生物学标记 静脉血栓栓塞症 D-二聚体 肿瘤 

分 类 号：R364.15[医药卫生—病理学]