治疗前血浆纤维蛋白原、血浆纤维蛋白降解产物及D-二聚体水平对非小细胞肺癌患者预后的预测价值  

Plasma fibrinogen,fibrinogen degradation products and D-dimer levels before treatment predict prognosis in non-small cell lung cancer

作　　者：车娟娟[1] 李卉惠[1] 甄洪超[1] 杨艳[2] 尚昆[1] 曹邦伟[1] CHE Juan-juan;LI Hui-hui;ZHEN Hong-chao(Oncology Department of Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing(100050),China)

机构地区：[1]北京友谊医院肿瘤科,北京100050 [2]北京友谊医院病理科,北京100050

出　　处：《中国中西医结合外科杂志》2023年第4期481-485,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：北京市自然基金(7212168)。

摘　　要：目的:探讨术前血浆纤维蛋白原(Fbg)、血浆纤维蛋白降解产物(FDP)及D-二聚体水平与非小细胞肺癌(NSCLC)预后及临床分期的关系。方法:纳入2013年7月—2017年11月于首都医科大学附属北京友谊医院确诊为NSCLC的患者377例。根据患者术前Fbg、FDP及D-二聚体水平分组,设定Fbg<3.498 g/L,FDP<3.165 g/L,血浆D-二聚体≤289.005μg/L为正常值,三项指标均为正常值者为低危组,仅1~2项高于正常值者为中危组,三者均高于正常值者为高危组。比较各组患者临床病理特征,统计患者5年生存率,比较各组间生存曲线的差异,多因素分析术前血浆Fbg、FDP及D-二聚体水平对患者预后的影响。通过受试者工作特征曲线(ROC)评价FDP、Fbg和D-二聚体单独及三个指标联合对NSCLC的诊断效能。结果:术前FDP、Fbg及D-二聚体水平与患者年龄、吸烟史、病理类型、病理分期、肿瘤大小及术后化疗相关。各组5年总生存率具有统计学差异,生存曲线提示高危组患者预后较差(低危组=94.4%;中危组=82.4%;高危组=64.4%,P<0.001)。多因素分析显示肿瘤大小及危险程度分组是完全性切除NSCLC患者预后的独立影响因素。FDP、Fbg和D-二聚体联合诊断NSCLC的诊断效能较好,优于单独指标。结论:FDP、Fbg和D-二聚体联合检测可作为预测完全切除术后NSCLC患者预后的潜在指标。Objective To investigate the relationship between Fbg,FDP,D-dimer level before operation and prognosis and clinical stage of non-small cell lung cancer.Methods A retrospective analysis of 377 NSCLC patients with definite pathological diagnosis in Beijing Hospital affiliated to Capital University from July 2013 to November 2017 were conducted.The patients were grouped according to the preoperative Fbg,FDP and D-dimer levels,and the normal values were set as Fbg<3.498 g/L,FDP<3.165 g/L,and plasma D-dimer≤289.005μg/L.Those with all three indexes being normal were considered as low-risk group,those with only 1-2 items higher than normal were considered as medium-risk group,and those with all three indexes higher than normal were considered as high-risk group.Clinical statistics were used to analyze the clinicopathologic characteristics of each group,and the 5-year survival rate of the patients was analyzed.The differences in survival curves among the groups were compared,and the influences of preoperative plasma Fbg,FDP and D-dimer levels on the prognosis of the patients were analyzed by multi-factors.Results Preoperative FDP,Fbg and D-dimer levels were correlated with age,smoking history,pathological type,pathological stage,tumor size and postoperative chemotherapy.The 5-year OS rate was statistically different among all groups,and the survival curve suggested that the high-risk group had a poor prognosis(low-risk group=94.40%;Intermediate risk group=82.40%;High-risk group=64.40%,P<0.001).Multivariate analysis showed that tumor size and risk were independent factors affecting the prognosis of patients with complete NSCLC.Conclusion The combined detection of FDP,Fbg and D-dimer can be used as a potential indicator to predict the prognosis of patients with NSCLC after complete resection.

关 键 词：非小细胞肺癌 纤维蛋白原 纤维蛋白原降解产物 D-二聚体 肿瘤分期 

分 类 号：R734.2[医药卫生—肿瘤]