三阴性乳腺癌患者凝血相关指标的检测及其临床意义  

Determination of coagulation-related parameters in triple negative breast cancer and clinical significance

作　　者：张萍[1] 陆肖玮[1] 宋卫[1] 丁云[1] 毛锦锋 马涛[1] 

机构地区：[1]江苏省无锡市妇幼保健院乳腺科,214002

出　　处：《中华乳腺病杂志（电子版）》2017年第6期349-353,共5页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：目的探讨三阴性乳腺癌(TNBC)患者凝血相关指标及其临床意义。方法依据患者的纳入和排除标准,收集2015年1月至2016年8月无锡市妇幼保健院收治的174例Ⅰ~Ⅲa期乳腺癌患者的病历资料进行回顾性研究。依据乳腺癌分子分型标准将患者分为luminal A型组32例、luminal B型组55例、HER-2过表达型组37例和TNBC组50例。另外纳入乳腺良性肿瘤患者36例为对照组。分析治疗前各入组患者的血浆凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间国际标准化比值(PT-INR)、纤维蛋白原(Fib)定量、血小板计数(BPC)等指标。凝血指标数据以x珋±s表示,多组间均数比较采用单因素方差分析,2组均数比较采用t检验,两两比较采用LSD法。结果 4组间凝血相关指标APTT、PT、PT-INR、Fib及TT差异有统计学意义(F=3.083、4.680、8.272、5.426、3.919,P均<0.050),而BPC差异无统计学意义(F=1.326,P=0.265)。TNBC组与对照组比较,APTT、PT、PT-INR显著降低[(25.92±2.80)s比(27.76±3.84)s,P<0.050;(11.77±0.68)s比(12.27±0.87)s,P<0.050;(0.99±0.59)s比(1.05±0.75)s,P<0.050],而Fib和TT显著升高[(2.59±0.45)s比(2.12±0.42)s,P<0.050;(20.07±1.31)s比(19.20±1.39)s,P<0.050]。TNBC组患者与luminal B型组比较,PT、PT-INR降低[(11.77±0.68)s比(12.21±0.69)s,P<0.050;(0.99±0.59)s比(1.04±0.06)s,P<0.050],Fib升高、TT延长[(2.59±0.45)s比(2.37±0.58)s,P<0.050;(20.07±1.31)s比(19.22±1.26)s,P<0.050];TNBC组与HER-2过表达组比较,TT延长[(20.07±1.31)s对(19.50±1.31)s,P<0.050]。TNBC患者中,有淋巴结转移者较无淋巴结转移者APTT缩短[(24.12±0.75)s比(26.43±2.70)s,t=-2.550,P=0.014];绝经后患者较绝经前患者PT缩短[(11.65±0.70)s比(12.08±0.55)s,t=-2.094,P=0.042],PT-INR降低[(0.98±0.61)s比(1.02±0.44)s,t=-2.272,P=0.028]。肿瘤直径≤2 cm者与>2~5 cm者比较,各凝血指标APTT、PT、PT-INR、Fib及TT差异无统计学意义(t=-0.946、0.225、-1.321、-1.098、-1.376、Objective To investigate the coagulation-related parameters in triple negative breast cancer （TNBC） patients and the clinical significance. Methods According to the inclusion and exclusion criteria, 174 patients with stage I to Ul a breast cancer in Wuxi Women and Children＇s Hospital from January 2015 to August 2016 were involved in this retrospective study. Based on molecular subtypes, there were 32 patients with luminal A subtype, 55 luminal B, 37 HER-2 overexpression and 50 TNBC. Another 36 patients with benign breast tumor served as control group. Before treatment, their whole blood and serum samples were collected for measuring the coagulation-related parameters, including prothrombin time （PT）, activated partial thromboplastin time （ APTr）, thrombin time （ IT）, prothrombin time-international normalized ratio （ PT-INR）, fibrinogen （Fib）, and blood platelet count （BPC）. All parameters were expressed as Yc＋s and compared among multiple groups using single factor analysis of variance. The mean values between two groups were compared using t test and pairwise comparison was performed using LSD method. Results There were significant differences in APTT, PT, PT-INR, Fib and TT among groups （F=3. 083, 4. 680, 8. 272, 5.426, 3. 919, P〈0. 050）, but there was no significant difference in BPC （F= 1. 326, P=0. 265）. The patients in TNBC group had significantly lower levels of AFFF, PT and PT-INR than those in control group [ （25.92 ± 2. 80） s vs （27. 76±3.84） s, P 〈0. 050; （ 11.77±0. 68） s vs （12. 27±0. 87） s, P〈0. 050; （0. 99±0. 59） s vs （1.05±0. 75） s, P 〈0. 050], while Fib and TT were significantly higher [ （2. 59±0.45） s vs （2. 12± 0.42） s, P〈0.050; （20.07＋1.31） s vs （19.20＋1.39） s, P〈0.050~. The patients in TNBC group had significantly lower PT and PT-INR compared with luminal B group [ （11.77±0. 68） s vs （12. 21±0. 69） s, P 〈 0. 050; （0. 99±0. 59） s vs （1.04±0.06） s, P〈0. 050], and signif

关 键 词：乳腺肿瘤 血液凝固 分子分型 静脉血栓形成 

分 类 号：R737.9[医药卫生—肿瘤]