血栓四项在恶性肿瘤患者静脉血栓形成中的应用研究  

Application of four items of thrombosis detection in venous thrombosis of malignant tumor patients

作　　者：周坤 周玉珍[1] 郑遵荣[1] 王立庄 Zhou Kun;Zhou Yuzhen;Zheng Zunrong;Wang Lizhuang(Department of Clinical Biochemistry Laboratory,General Hospital of Heilongjiang Province Land Reclamation Bureau,Harbin 150088,China)

机构地区：[1]黑龙江省农垦总局总医院检验科,哈尔滨150088

出　　处：《中国医师进修杂志》2019年第11期994-999,共6页Chinese Journal of Postgraduates of Medicine

基　　金：黑龙江省卫生计生委科研课题(2017-566)。

摘　　要：目的评价血栓四项包括凝血酶抗凝血酶复合物(TAT)、纤溶酶-α2纤溶酶抑制物复合物(PIC)、血栓调节蛋白(TM)、组织纤溶酶原激活物-抑制剂1复合物(t-PAIC)联合D-二聚体(D-D)、纤维蛋白降解产物(FDP)检测在恶性肿瘤患者静脉血栓形成中的应用价值.方法选取2017年10月至2019年3月黑龙江省农垦总局总医院恶性肿瘤患者904例(恶性肿瘤组),健康体检者200例(健康对照组).904例恶性肿瘤患者中,有静脉血栓形成92例(血栓组);无静脉血栓形成812例(无血栓组).所有入选者均检测TAT、PIC、TM、t-PAIC、FDP和D-D.采用二元Logistics回归分析TAT、PIC、TM、t-PAIC、D-D、FDP与恶性肿瘤患者静脉血栓形成的关系;受试者工作特征(ROC)曲线判断各指标的诊断效能,约登指数最大处作为检测项目的最佳截断值.结果恶性肿瘤组TAT、PIC、TM、t-PAIC、D-D和FDP明显高于健康对照组,差异有统计学意义(P<0.01).血栓组TAT、PIC、TM、t-PAIC、D-D和FDP明显高于无血栓组[20.20(12.30,59.45)μg/L比8.60(4.87,15.15)μg/L、1.23(0.69,2.84)mg/L比0.70(0.37,1.45)mg/L、14.55(8.12,21.10)kU/L比10.05(7.975,13.90)kU/L、10.20(7.30,15.17)μg/L比7.40(5.20,12.65)μg/L、3.42(1.38,7.07)μg/L比1.69(0.53,4.64)μg/L、6.41(3.21,17.05)mg/L比5.15(2.26,10.01)mg/L],差异有统计学意义(P<0.01或<0.05).二元Logistic回归分析结果显示,TAT、PIC、TM、t-PAIC、D-D、FDP均与恶性肿瘤患者的静脉血栓形成相关(OR=1.277、1.209、1.107、1.089、1.260、1.078和0.002,P<0.01或<0.05).ROC曲线分析结果显示,TAT、PIC、TM、t-PAIC、D-D和FDP预测恶性肿瘤患者静脉血栓形成的最佳截断值分别为24.450μg/L、2.624 mg/L、17.750 kU/L、13.250μg/L、5.290μg/L和22.435 mg/L,曲线下面积(AUC)分别为0.788、0.659、0.621、0.597、0.626和0.598.TAT+PIC+TM+t-PAIC、TAT+PIC+TM+t-PAIC+D-D+FDP诊断恶性肿瘤患者血栓形成的AUC明显高于D-D+FDP(0.808和0.796比0.633).选取TAT>24.450μg/L或PIC>2.624 mg/L的患者90�Objective To evaluate the clinical value of four items of thrombosis detection,including thrombin-antithrombin complex(TAT),α2-plasmin inhibitor-plasmin complex(PIC),thrombomodulin(TM)and tissue plasminogen activator-inhibitor complex(t-PAIC),combined with D-dimer(D-D)and fibrin degradation products(FDP)in venous thrombosis in patients with malignant tumor.Methods A total of 904 patients with malignant tumor from October 2017 to March 2019 in General Hospital of Heilongjiang Province Land Reclamation Bureau were selected(malignant tumor group),and 200 healthy physical examination patients were selected as healthy control group.Among 904 patients with malignant tumor,92 patients had venous thrombosis(thrombosis group),and 812 patients had not venous thrombosis(non-thrombosis group).The TAT,PIC,TM,t-PAIC,FDP and D-D were detected.The relationship between TAT,PIC,TM,t-PAIC,D-D,FDP and venous thrombosis was analyzed by binary Logistic regression.The receiver operating characteristic(ROC)curve was used to determine the diagnostic performance of each index,and the maximum value of the Youden index was the optimal cut-off value.Results The TAT,PIC,TM,t-PAIC,D-D and FDP in malignant tumor group were significantly higher than those in healthy control group,and there were statistical differences(P<0.01).The TAT,PIC,TM,t-PAIC,D-D and FDP in thrombosis group were significantly higher than those in non-thrombosis group:20.20(12.30,59.45)μg/L vs.8.60(4.87,15.15)μg/L,1.23(0.69,2.84)mg/L vs.0.70(0.37,1.45)mg/L,14.55(8.12,21.10)kU/L vs.10.05(7.975,13.90)kU/L,10.20(7.30,15.17)μg/L vs.7.40(5.20,12.65)μg/L,3.42(1.38,7.07)μg/L vs.1.69(0.53,4.64)μg/L,6.41(3.21,17.05)mg/L vs.5.15(2.26,10.01)mg/L,and there were statistical differences(P<0.01 or<0.05).Binary Logistic regression analysis result showed that TAT,PIC,TM,t-PAIC,D-D and FDP were correlated with venous thrombosis in patients with malignant tumor(OR=1.277,1.209,1.107,1.089,1.260,1.078 and 0.002;P<0.01 or<0.05).ROC curve result showed that the optimal cut-off values of TAT

关 键 词：肿瘤 静脉血栓形成 预测 血栓调节蛋白 凝血酶抗凝血酶复合物 纤溶酶-α2纤溶酶抑制物复合物 组织纤溶酶原激活物-抑制剂1复合物 

分 类 号：R73[医药卫生—肿瘤]