TAT-Ⅲ和F1+2对早期胰腺癌术后发生VTE的预测价值  

The predictive value of TAT-Ⅲ and F1 + 2 in VTE after early pancreatic cancer

作　　者：陈兵[1] CHEN Bing(Department of Gastrointestinal Oncology,the First Affiliated Hospital,Xinjiang Medical University,Urumqi,Xinjiang 830054,China)

机构地区：[1]新疆医科大学第一附属医院胃肠肿瘤外科

出　　处：《现代消化及介入诊疗》2019年第8期861-866,871,共7页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：目的寻找早期胰腺癌患者术后静脉血栓栓塞(VTE)的生物标志物,以便合理运用抗凝药物减少血栓事件。方法回顾性分析2016年4月至2018年4月我院收治的81例早期胰腺癌患者,根据术后是否发生VTE分为VTE组和非VTE组,对比分析两组的临床数据以及实验室参数,分析凝血酶/抗凝血酶Ⅲ复合物(TAT-Ⅲ)、凝血酶原片段(F1+2)和D-二聚体之间的相关性。分析D-二聚体、TAT-Ⅲ、F1+2对早期胰腺癌术后VTE的评估价值,探讨三者联合检测的评估价值。结果纳入非VTE组62例,VTE组19例,其中6例诊断为肺栓塞(PE),另有31.6%(6/19)的VTE事件发生在出院后,均诊断为DVT。VTE组D-二聚体、TAT-Ⅲ、F1+2在显著高于非VTE组(P<0.01),VTE组的Caprini评分、住院时间和死亡率均显著高于非VTE组(P<0.05)。在VTE事件发生时间上,PE患者较DVT患者显著提前(P<0.01),PE患者住院时间和Caprini评分均显著高于DVT患者(P<0.05)。TAT-Ⅲ、F1+2均与D-二聚体之间呈正相关(r=0.731,0.559,P<0.001)。D-二聚体、TAT-Ⅲ、F1+2对VTE均有一定对预测价值,AUC分别为0.848(95%CI 0.749~0.947)、0.880(95%CI 0.797~0.964)、0.895(95%CI 0.813~0.973)。D-二聚体、TAT-Ⅲ、F1+2联合检测对VTE预测的敏感度和特异度分别为94.7%和79.0%;kappa值为0.605,高于单项检测指标。结论D-二聚体、TAT-Ⅲ和F1+2可以作为早期检测胰腺癌患者术后发生VTE的生物学标记物,联合检测具有更高的敏感度。Objective To search for biomarkers of postoperative venous thromboembolism(VTE)in patients with early pancreatic cancer in order to rationally use anticoagulant drugs to reduce thrombotic events.Methods A retrospective analysis of 81 patients with early stage pancreatic cancer admitted to our hospital from April 2016 to April 2018 was divided into VTE group and non-VTE group according to whether VTE occurred after operation.The clinical data and laboratory parameters of the two groups were compared and analyzed.The correlation between thrombin/antithrombinⅢcomplex(TAT-Ⅲ),prothrombin fragment(F1+2)and D-dimer was analyzed.To evaluate the value of D-dimer,TAT-Ⅲand F1+2 in the evaluation of postoperative VTE in patients with early pancreatic cancer,and the evaluation value of the combined detection of the three.Results 62 patients in the non-VTE group and 19 patients in the VTE group were enrolled.6 of them were diagnosed with pulmonary embolism(PE),and another 31.6%(6/19)of the VTE events were diagnosed as DVT after discharge.The D-dimer,TAT-Ⅲand F1+2 in the VTE group were significantly higher than those in the non-VTE group(P<0.01).The Caprini score,hospitalization time and mortality in the VTE group were significantly higher than those in the non-VTE group(P<0.05).In the time of VTE event,PE patients were significantly earlier than DVT patients(P<0.01),PE patients’hospitalization time and Caprini score were significantly higher than DVT patients(P<0.05).There was a positive correlation between TAT-Ⅲand F1+2 and D-dimer(r=0.731,0.559,P<0.001).D-dimer,TAT-Ⅲ,and F1+2 have certain predictive value for VTE,with AUC of 0.848(95%CI 0.749~0.947),0.880(95%CI 0.797~0.964),and 0.895(95%CI).0.813~0.973).The sensitivity and specificity of D-dimer,TAT-Ⅲand F1+2 combined detection for VTE prediction were 94.7%and 79.0%,respectively;kappa value was 0.605,which was higher than single detection index.Conclusion D-dimer,TAT-Ⅲand F1+2 can be used as biomarkers for early detection of VTE in patients with pancreatic

关 键 词：早期胰腺癌术后 静脉血栓栓塞 D-二聚体 凝血酶/抗凝血酶Ⅲ复合物 凝血酶原片段1+2 

分 类 号：R604[医药卫生—外科学] R576[医药卫生—临床医学]