凝血-纤溶系统的改变对直肠癌患者预后的影响  

The Effect of Thrombin Fibrinolytic System on Prognosis of Colorectal Cancer Patients

作　　者：贺春燕[1] 王文达[2] 郑浩 张嘉琪 HE Chun- yan;WANG Wen- da;ZHENG Hao;ZHANG Jia- qi(Armed Police General Hospital. Digestive department. Beijing 100039, China;Shanxi Cancer Hospital. Colorectal and anal surgery, Taiyuan,030013;Armed Police General Hospital. General Surgery Department. Beijing 100039)

机构地区：[1]武警总医院消化科,北京100039 [2]山西省肿瘤医院结直肠肛门外科,太原030013 [3]武警总医院普外科,北京100039

出　　处：《血栓与止血学》2018年第3期426-428,共3页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的研究凝血纤溶系统的改变,即血小板聚集试验(PAg T)、凝血酶原时间(PT)、活化部分凝血活酶时间(a PTT)、组织因子途径抑制物(TFPI)及D二聚体(D-D)等指标的变化对直肠癌患者预后的影响。方法选取我院2016年4月至2017年4月接收的90例直肠癌患者作为研究对象,其中男性患者44例,女性患者46例,自身配对,治疗前后互相形成对照。患者术前血样检测结果显示凝血纤溶系统指标正常,并于患者进行手术前1天和术后两周取血检PAg T、PT、a PTT、TFPI及D-D等指标,记录手术前后的变化情况。对患者进行出院随访,调查记录并发症的发生情况,分析凝血纤溶系统的改变与术后患者发生并发症的关联。结果患者术前术后的PAg T变化(10.1±4.6)%,PT变化幅度为(1.3±0.5)s,a PTT变化幅度(5.9±1.8)s,TFPI的变化幅度为(5.6±1.4)μg/m L,D-D的变化幅度为(111.3±43.6)μg/L。患者出现并发症情况如下:术后出现出血患者共7例(7.78%),术后出现栓塞以及血栓患者共2例(2.22%)。其中PAGT、PT、a PTT、TFPI以及D-D的变化程度与患者并发症的发生率显著相关(P<0.05)。结论尽管患者术前凝血纤溶状态正常,但是术后各指标发生较大幅度的变化仍会增加出血或血栓发生风险。Objective To study the correlation between prognosis and the changes in indexes of coagulation fibrinolytic system,including platelet aggregation test（ PAg T）,prothrombin time（ PT）,activated partial thrombin time（ a PTT） live enzymes,tissue factor pathway inhibitor（ TFPI） and D-dimer（ D-D） of patients with colorectal cancer. Methods The 90 cases of colorectal cancer patients from April 2016 to April 2017 were selected as the research object. The 44 patients were male and 46 patients were female. The groups were contrasted each other before and after treatment. The preoperative blood tests of patients were normal,The blood PAg T,PT,a PTT,TFPI and D-D index were tested in one day of patients before surgery and postoperative two weeks,The changes of before and after surgery were recorded. The patient was discharged from the hospital and followed up. The occurrence of the disciplinary complications were investigated,and the correlation between the change of coagulant fibrinolytic system and the postoperative complications was analyzed. Results The changes of PAg T,PT,a PTT,TFPI and D-D was（ 10. 1 ± 4. 6） %,（ 1. 3 ± 0. 5） s,5. 9 ± 1. 8） s,（ 5. 6 ＋1. 4） mu g/m L and（ 111. 3-43. 6） μg/L. The complications were as follows： 7 cases of postoperative bleeding（ 7. 78 %）,2 cases of embolism and thrombosis（ 2. 22 %）. The changes of PAg T,PT,a PTT,TFPI and D-D were significantly correlated with the incidence of complications（ P〈0. 05）. Conclusion Although preoperative coagulant and fibrinolysis were normal,the significant changes in the postoperative indexes will increase the risk of bleeding or thrombosis.

关 键 词：凝血纤溶系统 直肠癌 预后 

分 类 号：R735[医药卫生—肿瘤]