化疗对于淋巴瘤患者凝血状态的影响及临床价值  

Effect of chemotherapy on coagulation state and its clinical value in patients with lymphoma

作　　者：徐杰 史阳阳 孙凯 XU Jie;SHI Yangyang;SUN Kai(Emergency Department,the First Affiliated Hospital of Nanjing Medical University,Nanjing,210000,China)

机构地区：[1]南京医科大学第一附属医院急诊科,南京210000

出　　处：《临床血液学杂志》2021年第6期385-389,共5页Journal of Clinical Hematology

基　　金：国家自然科学基金(No:81871544);江苏省科技厅基础研究计划(自然科学基金)(No:BK20181493)。

摘　　要：目的:探讨淋巴瘤患者化疗过程中凝血状态的变化及临床价值。方法:(1)收集2019年8月—2020年4月接受化疗的69例淋巴瘤患者初诊时的临床资料作为试验组,收集同期69例健康体检的患者资料作为对照组。比较2组患者凝血功能指标,血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、凝血酶时间(TT)、D-二聚体(DD)的指标水平,分析试验组与对照组指标差异。(2)依据淋巴瘤的分期、分组、分型及ECOG评分对凝血指标进行相关性分析,探讨是否存在关联性。(3)采集淋巴瘤患者3次化疗前后的凝血指标,探讨化疗前后凝血功能的变化。(4)收集患者3次化疗前的白细胞计数(WBC)、血红蛋白(HGB)、PLT、体重指数(BMI),总结Khorana评分,评估化疗进程中静脉血栓形成风险(VTE)。结果:(1)试验组相较于对照组PLT、PT、Fib及DD明显升高,差异有统计学意义(P<0.05)。(2)不同ECOG评分间DD分布存在明显差异,且DD与ECOG评分呈正相关。不同预后患者间初诊结果差异无统计学意义(P>0.05)。(3)前2次化疗后PLT均较化疗前明显降低。初次化疗后患者存在明显凝血功能异常,后逐渐恢复,但DD仍持续维持较高水平。(4)随着化疗次数的增加,Khorana评分为高风险患者比例逐渐上升。结论:淋巴瘤患者存在明显凝血功能异常,与化疗进程显著相关。在化疗过程中应密切监测凝血指标,及时发现患者凝血功能异常,并早期干预。Objective: To investigate the changes of coagulation state and its clinical value in patients with lymphoma during chemotherapy. Methods:(1)Clinical data of 69 lymphoma patients receiving chemotherapy in our hospital from August 2019 to April 2020 were collected at the time of initial diagnosis as the observation group, and data of 69 patients receiving physical examination in our hospital during the same period were collected as the control group. Thrombin function indicators such as platelet count(PLT), prothrombin time(PT), partial thrombin activation time(APTT), fibrinogen(Fib), thrombin time(TT) and D-dimer(DD) were compared between the two groups, and the differences between the observation group and the control group were analyzed.(2)Correlation analysis was conducted on coagulation indicators according to the stage, grouping, typing and ECOG score of lymphoma to explore whether there was any correlation.(3)Coagulation indexes of lymphoma patients before and after 3 rounds of chemotherapy were collected to investigate the changes of coagulation function before and after chemotherapy.(4)White blood cell count(WBC), hemoglobin(HGB), PLT and body mass index(BMI) of patients before 3 rounds of chemotherapy were collected, and Khorana score was summarized to evaluate the risk of venous thrombosis(VTE) during chemotherapy. Results:(1)PLT, PT, Fib and DD in the lymphoma group were significantly increased compared with those in the control group, and the difference was statistically significant(P<0.05).(2)DD distribution was significantly different among different ECOG scores, and DD was positively correlated with ECOG scores. There was no significant difference in initial diagnosis among patients with different prognosis(P>0.05).(3)PLT after the first two chemotherapy treatments was significantly lower than that before chemotherapy. After the initial chemotherapy, the patients had obvious coagulation dysfunction and gradually recovered, but DD was still maintained at a high level.(4)With the increase of the numbe

关 键 词：淋巴瘤 高凝状态 血小板降低 治疗 

分 类 号：R733.4[医药卫生—肿瘤]