凝血酶-抗凝血酶复合物和纤溶酶-ɑ2纤溶酶抑制物复合物优于D二聚体用于肿瘤患者血栓的诊断  

TAT and PIC better than D-dimer in monitoring hypercoagulability of cancer patients

作　　者：崔婵娟 崔巍 高佳 李佳 严翠娥 于梦瑶 Cui Chanjuan;Cui Wei;Gao Jia;Li Jia;Yan Cuie;Yu Mengyao(National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]中国医学科学院肿瘤医院检验科,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院,北京100021

出　　处：《中华检验医学杂志》2019年第10期853-857,共5页Chinese Journal of Laboratory Medicine

基　　金：中国医学科学院医学与健康科技创新工程(2017-I2M-3-005);国家自然科学基金面上项目(81772272)。

摘　　要：目的观察恶性肿瘤患者体内血浆凝血纤溶情况,探讨凝血纤溶标志物在诊断恶性肿瘤患者血栓中的作用。方法收集2017年9月至2019年7月间于中国医学科学院肿瘤医院就诊的171例患者,其中肿瘤术后无血栓组患者40例,术前无血栓对照组患者108例,未手术肿瘤血栓患者23例。分别检测凝血酶-抗凝血酶复合物(TAT)、纤溶酶-ɑ2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/纤溶酶原激活物抑制剂-1复合物(t-PAI?C)的水平,并与D二聚体进行比较。结果TAT、TM、PIC及t-PAI?C在肿瘤术前无血栓组、术后无血栓组及未手术血栓组三组间均具有显著统计学差异(均P<0.05);在恶性肿瘤未手术血栓组患者中,TAT、TM及PIC均高于无血栓组患者(均P<0.05)。ROC显示PIC及TAT诊断肿瘤患者血栓的AUC均高于D-D(0.871 vs.0.619;0.788 vs.0.619);且PIC诊断的特异度高于D-D(91.9%vs.82.4%),PIC及TAT诊断的灵敏度均高于D-D(73.9%vs.47.8%,73.9%vs.47.8%)。结论恶性肿瘤患者体内凝血与纤溶活性异常增强,TAT及PIC优于D-D对恶性肿瘤患者血栓的诊断。Objective The aim of this study is to investigate the variation tendency of coagulation and fibrinolysis biomarkers in cancer patients and to explore the effect of these biomarkers for the diagnosis of thrombosis in cancer patients.Methods 171 cancer patients admitted to hospital from September 2017 to July 2019 were enrolled in the study,including 40 cancer patients undergoing surgery,108 cancer patients without surgery in control group and 23 cancer patients with thrombus.New coagulation and fibrinolysis biomarkers,TM(Thrombomodulin),TAT(Thrombin-antithrombin complex),PIC(Plasmin alpha 2-plasmin inhibitor complex)and t-PAI·C(Tissue plasminogen activator-plasminogen activator inhibitor-1 complex),were tested in every patient.In addition,these new biomarkers are compared with D-dimer.Results A statistically difference was available on the value of TAT,TM,PIC,t-PAIC,between postoperative cancer patients group and control group(P<0.05,respectively).TAT,TM and PIC in thrombosis cancer group were higher than those in non-thrombosis cancer group(P<0.05;respectively).ROC was used to evaluate the performance of D-dimer,TAT and PIC on thrombosis in cancer patients.The results showed that the AUC of PIC and TAT were both higher than D-dimer(0.871 vs.0.619;0.788 vs.0.619).The specificity of PIC alone was higher than that of D-dimer(91.9%vs.82.4%),and the sensitivity of PIC and TAT alone was higher than that of D-dimer(73.9%vs.47.8%,73.9%vs.47.8%,respectively).Conclusions The activity of coagulation and fibrinolysis in cancer patients was abnormally enhanced.TAT and PIC were better than D-dimer for the diagnosis of thrombosis in cancer patients.

关 键 词：肿瘤 血栓形成倾向 α-2抗纤维蛋白溶酶 纤维蛋白溶酶 抗凝血酶类 纤维蛋白纤维蛋白原降解物 生物标记 肿瘤 

分 类 号：R[医药卫生]