结直肠癌合并2型糖尿病患者FIB和D-dimer与临床病理特征相关性分析  

Plasma levels of fibrinogen and D-dimer in colorectal cancer patients with type 2 diabetes and its relationship with clinicopathological characteristics

作　　者：王茹瑶 刘蕊[2] 赵立杰[2] 许丹丹[2] 胡丽玲[2] 吴萍[2] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市人民医院检验学部,天津300121

出　　处：《中华肿瘤防治杂志》2017年第5期332-336,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的肿瘤患者体内凝血系统异常活化,而糖尿病患者体内也存在多种促凝和抗凝成分的改变。本研究探讨结直肠癌(colorectal cancer,CRC)合并2型糖尿病(type 2diabetes mellitus,T2DM)以及单纯CRC患者血浆纤维蛋白原(fibrinogen,FIB)和D-二聚体(D-dimer)的变化,及FIB、D-dimer与CRC合并T2DM患者临床病理特征之间的关系。方法选取2011-03-07-2015-09-25天津市人民医院住院患者1 141例。分为合并组274例和CRC组867例,合并组为CRC合并T2DM患者,CRC组为单纯CRC患者。检测空腹血糖(Glu)、FIB和D-dimer,比较两组差异。应用单因素方差分析和t检验比较患者不同临床病理特征FIB水平的差异,应用非参数检验比较患者不同临床病理特征D-dimer水平的差异。结果合并组FIB水平为(4.16±1.066)g/L,高于CRC组的(3.96±0.935)g/L,t=-2.727,P=0.007;合并组D-dimer水平为0.38(0.26,0.67)mg/L,CRC组D-dimer水平为0.40(0.26,0.66)mg/L,两者比较差异无统计学意义,Z=0.168,P=0.867。合并组肿瘤长径≥5cm者FIB(4.41±1.03)g/L高于肿瘤长径<5cm者(3.87±1.01)g/L,t=-3.946,P<0.001;pT_(3-4)期肿瘤患者FIB(4.21±1.04)g/L高于pT_1~T_2期的(3.78±1.01)g/L,t=-2.295,P=0.023;低、中分化患者FIB水平(4.70±1.00、4.20±1.03)g/L高于高分化患者(3.83±1.10)g/L,F=4.262,P=0.015。合并组女性D-dimer水平0.51(0.32,1.08)mg/L高于男性0.34(0.26,0.55)mg/L,Z=3.797,P<0.001;结肠癌患者D-dimer水平0.47(0.31,0.78)mg/L高于直肠癌患者0.34(0.26,0.61)mg/L,Z=2.492,P=0.013;pT_3~T_4期患者D-dimer水平0.39(0.26,0.72)mg/L高于pT_1~T_2期者0.32(0.24,0.42)mg/L,Z=2.090,P=0.037。结论 CRC合并T2DM患者血液处于高凝状态。CRC合并T2DM患者术前高FIB和D-dimer水平与较大的肿瘤直径和较差的肿瘤病理分期、分化有关。OBJECTIVE To explore plasma fibrinogen（FIB）and D-dimer levels in colorectal cancer（CRC）patients with and without type 2 diabetes mellitus（T2DM）,and relationship of FIB and D-dimer levels with clinicopathological characteristics of CRC.METHODS A total of 1 141 inpatients of CRC with T2DM and CRC without T2DM treated in Tianjin Union Medical Center during the period of 3/7/2011-9/25/2015 were selected.Fasting blood glucose（Glu）,FIB and D-dimer levels were quantified and compared.ANOVA and t test were used to test the difference of FIB among different clinical characteristics.Non-parametric test was used to test the difference of D-dimer among different clinical characteristics.RESULTS FIB levels of CRC patients with T2DM（4.16±1.066）g/L were higher than that of CRC patients without T2DM（3.96±0.935）g/L（t=-2.727,P=0.007）.There was no statistical difference of D-dimer levels between CRC patients with 0.38（0.26,0.67）mg/L and without T2DM 0.40（0.26,0.66）mg/L（Z=0.168,P=0.867）.Among patients of CRC with T2DM,FIB levels of tumor diameters ≥5cm（4.41±1.03）g/L were higher than that5cm（3.87±1.01）g/L（t=-3.946,P〈0.001）;Patients with tumor pT3-T4 showed higher FIB levels（4.21±1.04）g/L than pT1-T2（3.78±1.01）g/L（t=-2.295,P=0.023）;poorly（4.70±1.00）g/L and moderately（4.20±1.03）g/L differentiation was associated with higher FIB levels（F=4.262,P=0.015）than high differentiation（3.83±1.10）g/L.Higher D-dimer levels were observed in female 0.51（0.32,1.08）mg/L than male 0.34（0.26,0.55）mg/L（Z=3.797,P〈0.001）,and also in colonic cancer patients 0.47（0.31,0.78）mg/L than rectal cancer patients 0.34（0.26,0.61）mg/L（Z=2.492,P=0.013）;patients of pT3-T4 0.39（0.26,0.72）mg/L had elevated D-dimer levels than pT1-T2 0.32（0.24,0.42）mg/L（Z=2.090,P=0.037）.CONCLUSIONS CRC patients with T2DM are in hypercoagulability.In CRC patients with T2DM,higher preoperative plasma FIB and D-dimer levels are associated with larger tumor size,po

关 键 词：结直肠癌 2型糖尿病 纤维蛋白原 D-二聚体 

分 类 号：R587.1[医药卫生—内分泌] R735.34[医药卫生—内科学]