肺癌合并血管栓塞性疾病患者外周血凝血功能和炎症因子变化及其临床意义  

Changes of peripheral blood coagulation function and inflammatory factors in patients with lung cancer complicated with vascular embolic disease and their clinical significance

作　　者：陈旭如 揭志军[1] 钱凌 丁怡[1] 蒋蓉 张佳彦 CHEN Xuru;JIE Zhijun;QIAN Ling;DING Yi;JIANG Rong;ZHANG Jiayan(Department of Respiratory and Critical Diseases,Shanghai Fifth People's Hospital,Fudan University Community Health Research Center(Preparatory),Shanghai 200240,China;不详)

机构地区：[1]上海市第五人民医院复旦大学社区健康研究中心(筹)呼吸与危重症医学科,上海200240 [2]上海市第八人民医院药剂科

出　　处：《山东医药》2022年第25期1-5,共5页Shandong Medical Journal

基　　金：上海市卫生和计划生育委员会卫生行业临床研究专项计划(20184Y0240);闵行区自然科学研究课题(2020MHZ014)。

摘　　要：目的 探讨肺癌合并血管栓塞性疾病患者外周血凝血功能和炎症因子变化及其临床意义。方法 选择肺癌合并血管栓塞性疾病患者120例(合并栓塞组)、单纯肺癌患者70例(单纯肺癌组)、健康志愿者60例(健康对照组),采集所有研究对象空腹外周静脉血,检测凝血功能[包括血小板(PLT)计数、凝血因子Ⅷ(FⅧ)、D-二聚体(D-D)、凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(FIB)]和炎症因子[包括高敏C反应蛋白(hs-CRP)、降钙素原(PCT)、TNF-α、IL-6、IL-1β]。比较三组外周血凝血功能和炎症因子水平。肺癌合并血管栓塞性疾病患者接受维持性化疗3个周期,同时给予低分子肝素钙皮下注射、华法林口服。化疗3个周期后,评估治疗效果,比较治疗有效者与治疗无效者外周血凝血功能和炎症因子水平。采用受试者工作特征(ROC)曲线分析外周血凝血功能和炎症因子水平对肺癌合并血管栓塞性疾病患者治疗有效的预测价值。结果 合并栓塞组外周血PLT计数、FⅧ、D-D、TT、FIB均高于单纯肺癌组和健康对照组(P均<0.05),单纯肺癌组外周血FⅧ、D-D、TT、FIB均高于健康对照组(P均<0.05),而三组外周血PT比较P>0.05。合并栓塞组血清hs-CRP、PCT、TNF-α、IL-6、IL-1β水平均高于单纯肺癌组和健康对照组,并且单纯肺癌组血清hs-CRP、PCT、TNF-α、IL-6、IL-1β水平均高于健康对照组(P均<0.05)。肺癌合并血管栓塞性疾病患者化疗3个周期后,治疗有效72例、治疗无效48例。治疗有效者外周血PLT计数、FⅧ、D-D、FIB均低于治疗无效者(P均<0.05),而外周血TT、PT比较P均>0.05;治疗有效者血清hs-CRP、PCT、TNF-α、IL-6、IL-1β水平均低于治疗无效者(P均<0.05)。ROC曲线分析显示,外周血PLT计数、FⅧ、D-D、FIB、hs-CRP、PCT、TNF-α、IL-6、IL-1β水平对肺癌合并血管栓塞性疾病患者治疗有效均有一定预测价值(P均<0.05)。其中,在凝血功能中,外Objective To investigate the changes of peripheral blood coagulation function and inflammatory factors in patients with lung cancer complicated with vascular embolic disease and their clinical significance.Methods A total of 120 patients with lung cancer complicated with vascular embolism disease(combined with embolism group),70 patients with lung cancer(lung cancer group),and 60 healthy volunteers(healthy control group) were selected.The coagulation function [platelet(PLT) count,coagulation factor Ⅷ(FⅧ),D-dimer(D-D),thrombin time(TT),prothrombin time(PT),and fibrinogen(FIB)] and inflammatory factors [high-ssensitivity C-reactive protein(hs-CRP),procalcitonin(PCT),tumor necrosis factor-α(TNF-α),interleukin 6(IL-6),and interleukin 1β(IL-1β)] in the peripheral blood in these three groups were recorded and compared.Lung cancer patients with vascular thromboembolic disease received three cycles of maintenance chemotherapy,and were given subcutaneous injection of low molecular weight heparin calcium and oral warfarin.After chemotherapy,the therapeutic effect was evaluated,and the peripheral blood coagulation function and the levels of inflammatory factors were compared between the effective and ineffective patients.The receiver operating characteristic(ROC) curve was used to analyze the efficacy of peripheral blood coagulation function and inflammatory factor on the treatment of patients with lung cancer complicated with vascular embolic disease.Results The peripheral blood PLT count,FⅧ,D-D,TT,and FIB in the combined with embolism group were higher than those in the lung cancer group and the healthy control group(all P<0.05).The peripheral blood FⅧ,D-D,TT,and FIB in the lung cancer group were higher than those in the healthy control group(all P<0.05).No significant difference was found in the PT among three groups(P<0.05).The hs-CRP,PCT,TNF-α,IL-6,and IL-1β in the combined with embolism group were higher than those in the lung cancer group and the healthy control group(all P<0.05).The hs-CRP,PCT,TNF-α,I

关 键 词：肺癌 血管栓塞性疾病 凝血功能 炎症因子 

分 类 号：R734.2[医药卫生—肿瘤] R563.5[医药卫生—临床医学]