肿瘤患者凝血功能异常时凝血因子活性变化及临床意义  

Changes of coagulation factor activity and its clinical significance in tumor patients with abnormal coagulation function

作　　者：邵树军[1] 祁欣 刘宗健[1] 董晓锋[1] 叶昱坪[1] 周虎[2] 谢广伦[3] Shao Shujun;Qi Xin;Liu Zongjian;Dong Xiaofeng;Ye Yuping;Zhou Hu;Xie Guanglun(Department of Blood Transfusion,Henan Cancer Hospital,Zhengzhou 450008,China;Department of Hematology,Henan Cancer Hospital,Zhengzhou 450008,China;Department of Pain Rehabilitation and Palliative Care,Henan Cancer Hospital,Zhengzhou 450008,China)

机构地区：[1]河南省肿瘤医院输血科,郑州450008 [2]河南省肿瘤医院血液科,郑州450008 [3]河南省肿瘤医院疼痛康复与姑息治疗科,郑州450008

出　　处：《中华医学杂志》2021年第47期3845-3849,共5页National Medical Journal of China

基　　金：国家自然科学基金(82070120);河南省医学科技攻关项目(201702362)。

摘　　要：目的探讨肿瘤患者凝血功能异常时凝血因子活性变化及临床意义。方法收集2020年1月至2021年6月在河南省肿瘤医院住院接受治疗的肿瘤患者的临床资料。采用血栓弹力图(TEG)监测其凝血功能,凝血功能呈异常状态的196例肿瘤患者为试验组,呈正常状态的36例肿瘤患者为对照组。根据TEG检测结果的总体凝血指标(CI)值将试验组分为两组:高凝试验组(n=104):CI值>3;低凝试验组(n=92):CI值<-3。每个试验组再根据TEG结果的R值、K值、α角、MA值分成3个亚组,即高凝一组(n=37)、高凝二组(n=34)、高凝三组(n=33);低凝一组(n=33)、低凝二组(n=30)、低凝三组(n=29)。同期测定并比较试验组和对照组所有患者凝血因子(F)Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅸ、Ⅹ、Ⅺ、Ⅻ和血管性血友病因子(vWF)的活性。结果与对照组比较,高凝一组FⅡ、FⅤ、FⅦ、FⅧ、FⅪ和vWF活性升高,分别为(1105±281)、(1352±326)、(1628±397)、(1795±314)、(1389±288)和(1908±486)U/L(均P<0.01);高凝二组FⅡ、FⅤ、FⅦ、FⅧ、FX和vWF活性升高,分别为(1068±189)、(1194±205)、(1529±394)、(1562±241)、(1150±196)和(1722±415)U/L(均P<0.05);高凝三组FⅦ、FⅩ和vWF活性升高,分别为(1411±196)、(1212±327)和(1713±457)U/L(均P<0.01)。低凝一组FⅤ、FⅧ、FⅨ、FⅫ和vWF活性降低,分别为(732±96)、(695±64)、(1216±191)、(832±128)和(1088±117)U/L(P<0.05);低凝二组FⅤ、FⅦ、FⅧ和FⅫ活性降低,分别为(714±102)、(1125±108)、(783±95)和(912±111)U/L(P<0.01);低凝三组FⅪ、FⅫ和vWF活性降低,分别为(812±92)、(827±179)和(916±76)U/L(P<0.01)。结论肿瘤患者凝血功能异常时仅有部分凝血因子活性发生明显改变。高凝状态时,FⅡ和FⅩ的活性较高,成为抗凝治疗的重要因素,FⅤ、FⅧ活性升高易引发深静脉血栓;低凝状态时,FⅤ和FⅧ活性显著下降,常引发出血或渗血。Objective To investigate the changes and clinical significance of coagulation factor activity in tumor patients with abnormal coagulation function.Methods The clinical data of cancer patients who were hospitalized in Henan Cancer Hospital from January 2020 to June 2021 was collected.Thromboelastography(TEG)was used to monitor the coagulation function of tumor patients.Accordingly,196 tumor patients with abnormal coagulation function were in the test group,and 36 tumor patients with normal status were in the control group.According to the coagulation index(CI)value of the TEG test results,the test group was divided into two groups:hypercoagulability test group(n=104):CI value>3;hypocoagulation test group(n=92):CI value<-3.Meanwhile,each test group was divided into 3 subgroups according to the R value,K value,αangle and MA value of the TEG results,namely hypercoagulable group one(n=37),hypercoagulable group two(n=34),and hypercoagulable group three(n=33);hypocoagulation group one(n=33),hypocoagulation group two(n=30),and hypocoagulation group three(n=29).The activities of coagulation factors(F)Ⅱ,Ⅴ,Ⅶ,Ⅷ,Ⅸ,Ⅹ,Ⅺ,Ⅻand von willebrand factor(vWF)were measured and compared for all patients in the test groups and the control group in the same period.Results Compared with the normal control group,the hypercoagulable group one showed higher FⅡ,FⅤ,FⅦ,FⅧ,FⅪand vWF activity,and the values were(1105±281),(1352±326),(1628±397),(1795±314),(1389±288)and(1908±486)U/L,respectively(P<0.01).The hypercoagulable group two showed higher FⅡ,FⅤ,FⅦ,FⅧFⅩand vWF activity,and the values were(1068±189),(1194±205),(1529±394),(1562±241),(1150±196)and(1722±415)U/L,respectively(P<0.05).Hypercoagulable group three showed higher FⅦ,FⅩand vWF activity,and the values were(1411±196),(1212±327)and(1713±457)U/L,respectively(P<0.01).In contrast,the hypocoagulation group one showed lower FⅤ,FⅧ,FⅨ,FⅫand vWF activity,and the values were(732±96),(695±64),(1216±191),(832±128)and(1088±117)U/L,resp

关 键 词：肿瘤 凝血因子 凝血功能 血栓弹力图 

分 类 号：R730.2[医药卫生—肿瘤]