抗凝治疗在恶性肿瘤前血栓状态中的应用  

Anticoagulation therapy in cancer patients with pre-thrombotic state

作　　者：崔林[1] 陈珏 孙友红[3] 刘建军[1] 刘兴祥[1] 周向荣[1] 丁洁[1] 朱余久[1] 

机构地区：[1]泰州市第二人民医院肿瘤科,江苏泰州22550 [2]扬州大学研究生院,江苏扬州225000 [3]泰州市第二人民医院妇科,江苏泰州225500

出　　处：《现代肿瘤医学》2016年第3期468-471,共4页Journal of Modern Oncology

基　　金：江苏省泰州市科技发展计划项目(编号:2013068);江苏大学医学临床科技发展基金项目资助(编号:JLY20140144)

摘　　要：目的:分析抗凝治疗在恶性肿瘤前血栓状态中的临床应用价值。方法:2012年1月-2014年12月间,采用前瞻性随机对照的研究方法,检测肿瘤病例的D-二聚体(D-dimer,D-D)水平,确定是否合并前血栓状态。根据是否合并前血栓状态将肿瘤病例分为三组:D-D正常组、D-D异常给予抗凝治疗组、D-D异常未给予抗凝治疗组,抗凝药物选用肝素/华法林/拜阿司匹林等,统计各组血栓发生率。结果:2 663例中,D-D异常1 177例,异常率44.2%。发生血栓12例,血栓发生率0.45%。D-D正常组1 486例中发生血栓3例(0.20%),D-D异常组1 177例中,发生静脉血栓9例(0.76%)。其中,D-D异常给予抗凝治疗组1 005例中发生5例(0.50%),未给予抗凝治疗组172例中发生4例(2.33%),三组比较差异有显著性(P<0.01)。主要副反应为急性胃黏膜病变,未见消化道大出血等严重并发症发生。结论:合并前血栓状态的肿瘤病人给予抗凝治疗可以有效预防静脉血栓的发生率,提高病人的生活质量。Objective： To explore the efficacy of anticoagulation in clinical practice for pre -thrombotic state. Methods： Serum D - dimer level was employed to discriminate cancer patients with or without PTS by randomized study, then eligible cancer patients were divided into negative control group （ with normal D - dimer level）, therapy group（ with abnormal D -dimer level received anticoagulation ） and positive control group（ with abnormal D -dimer level unreceived anticoagulation）. After a period of therapy with heparin, warfarin or aspirin, occurrence ratio of thrombus were calculated. Results：In total 2 663 patients, 1 486 patients （55.8%） confirmed without abnormal serum D - dimer level were observed with an occurrence ratio of thrombus about 0.20% （3/1 486）. By comparison,in 1 177 cases （44.2%） with abnormal D - dimer level,9 patients （0.76%） were checked up with venous thrombus. In those 1 005 patients with PTS received anticoagulation,5 cases were confirmed with venous thrombus, while in the 172 patients unreceived anticoagulation with 2.33% （4/177）. The significant differences were demonstrated among the three groups. The main adverse reactions were acute gastric mucosal lesions. No major complications such as massive hemorrhage occurred in the digestive tract. Conclusion：Anticoagnlation therapy palys an important role in prevention for the occurrence of veinous thrombus in cancer patients and thus could contribute to the provement of quality of life.

关 键 词：恶性肿瘤 前血栓状态 抗凝治疗 静脉血栓 前瞻性研究 

分 类 号：R730.53[医药卫生—肿瘤]