肺癌伴肺栓塞患者影像学和临床因素与D-二聚体的相关性研究  

Correlation of plasma D-Dimer levels with imaging and clinical factors of lung cancer with pulmonary embolism

作　　者：杨翠翠[1] 付正[1] 杨慧[2] 郭沐洁[3] 吴玉芬[1] 

机构地区：[1]山东省肿瘤医院CT室,山东济南250117 [2]泰山医学院附属医院CT室,山东泰安271000 [3]济宁医学院附属医院CT室,山东济宁272129

出　　处：《中华肿瘤防治杂志》2016年第5期318-321,330,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：山东省医药卫生科技发展计划面上项目(2014WS0058);山东省自然科学基金(ZR2011HL028);山东省中医药科技发展计划(2013-212)

摘　　要：目的肺癌患者易并发肺栓塞，死亡风险增加。D-二聚体（DD）是肺栓塞常用辅助诊断指标，与恶性肿瘤进展、转移及预后关系密切。本研究分析肺癌合并肺动脉栓塞患者影像学及临床因素与DD之间的相关性。方法收集2014-09-01—2015—08—31山东省肿瘤医院收治的病理确诊为肺癌，并经多层螺旋CT显示有肺栓塞者59例作为研究对象，回顾性分析其影像学和临床资料．根据栓子影像指标和患者临床资料分组分析，运用SPSS17．0统计学软件分析其与DD的相关性。结果瘤栓组（n=30）平均血浆DD水平为11．29mg／L，血栓组（n=29）为7．48mg／L，差异有统计学意义，P=0．049。Ⅲ～Ⅳ期患者（n=21）平均血浆DD水平为10．13mg／L，Ⅰ～Ⅱ期（n=38）为7．96mg／L，差异有统计学意义，P=0．042。淋巴结转移组（n=45）平均血浆DD水平为11．01mg／L，无淋巴结转移组（n=14）为4．31mg／L，差异有统计学意义，P=0．006。发生远处转移组（n=39）平均血浆DD水平为9．88mg／L，无远处转移组（n=20）为7．76mg／L，差异有统计学意义，P=0．045。分化差肺癌患者（n=36）平均DD水平为10．67mg／L，分化良好肺癌患者（n=23）为6．8mg／L，差异有统计学意义，P=0．039。肿瘤标记物升高组（n=39）平均血浆DD为10．65mg／L，正常组（n=20）为6．26mg／L，差畀有统计学意义，P=0．023。结论DD水平在瘤栓、晚期患者、淋巴结转移、远处转移、分化差、肿瘤标记物升高的患者较高，与上述因素间有相关性。DD在肺癌并发肺栓塞的预防、诊断、治疗等方面有一定临床价值。OBJECTIVE Pulmonary embolism is common complications of lung cancer, which increased the risk of death. D-Dimer（DD） ia always used for auxiliary diagnosis of pulmonary embolism, which is closely associated with progression,metastasis and prognosis of malignancy. The objective of this study was to analyze the relationship between D-Dimer levels and the clinical and imaging features of lung cancer with pulmonary embolism. METHODS Totally 59 cases of patients with pathologically and multi-slice computed tomography confirmed lung cancer were enrolled, from Sep. 2014 to Aug. 2015, Shandong Cancer Hospital. The imaging and clinical data were retrospectively analyzed to discuss its relevance to the DD using SPSS17.0. RESULTS The average of the plasma DD levels for tumor embolus was significantly higher than the thrombus subjects （11.29 vs 7.48,P=0. 049）. The average of the plasma DD levels for stage Ⅲ and Ⅱwere higher than stage Ⅱ and Ⅰ （10.13 vs 7.96,P=0. 042）. The average of the plasma DD levels for lymphnode metastasis significantly exceeded patients without lymphnode metastasis （11.01 vs 4.31, P = 0. 006）. The average of the plasma D-Dimer levels for distant metastasis exceeded patients without distant metastasis （9.88 vs 7.76 ,P=0. 045）. The average of the plasma DD levels for poorly differentiation was higher than well differentiation （10.67 vs 6.8 ,P=0. 039）. The av erage of the plasma DD levels for increased tumor-markers was significantly higher than tumor-markers normally （10.65 vs 6.26, P=0. 023）. CONCLUSIONS Tumor embolus, advanced stages, lymphnode metastasis, distant metastasis, poorly differentiation and increased tumor-markers have high DD levels, which has statistically difference with DD. DD has clinical value in prevention, diagnosis and treatment in lung cancer with pulmonary embolism.

关 键 词：肺肿瘤 肺动脉栓塞 D二聚体 CT 

分 类 号：R734.2[医药卫生—肿瘤]