早期宫颈癌患者凝血酶原时间国际标准化比值的变化及对术后下肢深静脉血栓的预测价值  

Changes of international normalized ratio of prothrombin time in patients with early cervical cancer and its predictive value for postoperative lower extremity deep venous thrombosis

作　　者：曹敏华 冯冠男[1] 周冬梅 CAO Minhua;FENG Guannan;ZHOU Dongmei(Department of Gynaecology and Obstetrics,Suzhou Hospital Affiliated to Nanjing Medical University(Suzhou Municipal Hospital),Suzhou 215000,Jiangsu,China)

机构地区：[1]南京医科大学附属苏州医院(苏州市立医院)妇产科,苏州215000

出　　处：《中国性科学》2024年第1期70-74,共5页Chinese Journal of Human Sexuality

基　　金：江苏省社会发展—重点病种规范化诊疗项目(BE2015645)。

摘　　要：目的观察早期宫颈癌患者围术期凝血酶原时间国际标准化比值(INR)的动态变化,并分析INR对术后发生下肢深静脉血栓(LEDVT)的预测价值。方法前瞻性纳入2019年2月至2023年1月在南京医科大学附属苏州医院接受改良根治性子宫切除术治疗的122例宫颈癌患者作为研究对象,根据患者术后15 d内LEDVT发生情况分组,分为LEDVT组和N-LEDVT组。检测患者术前(T_(1))及术后第1天(T_(2))、第2天(T_(3))、第3天(T_(4))时凝血指标[凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、血浆纤维蛋白原(FIB)、D-二聚体(D-D)、INR],分析早期宫颈癌患者围术期INR对术后发生LEDVT的预测价值。结果自T_(2)开始,两组患者TT、PT、APTT均缩短,血浆FIB、D-D升高,INR降低(P<0.05)。两组不同时间TT、PT、APTT动态变化趋势比较,差异无统计学意义(P>0.05);LEDVT组T_(2)~T_(4)血浆FIB、D-D均高于N-LEDVT组,INR低于N-LEDVT组(P<0.05)。绘制受试者工作特征(ROC)曲线显示,早期宫颈癌患者围术期血浆FIB、D-D、INR预测术后LEDVT发生风险的曲线下面积(AUC)分别为0.681、0.671、0.816。结论早期宫颈癌患者自术后第1天开始INR即开始下降,且其可提示术后LEDVT的发生风险。Objective To observe the dynamic changes of the international normalized ratio(INR)of prothrombin time in patients with early cervical cancer during the perioperative period,and to analyze the predictive value of INR in predicting postoperative lower extremity deep venous thrombosis(LEDVT).Methods A total of 122 patients with cervical cancer who received modified radical hysterectomy in Suzhou Hospital Affiliated to Nanjing Medical University from February 2019 to January 2023 were prospectively included as the study subjects.They were divided into LEDVT group and N-LEDVT group based on the occurrence of LEDVT within 15 days after surgery.The coagulation indexes[thrombin time(TT),prothrombin time(PT),activated partial prothrombin time(APTT),plasma fibrinogen(FIB),D-dimer(D-D),INR]were measured before operation(T_(1)),on the first day(T_(2)),on the second day(T_(3)),and on the third day(T_(4))after operation.The predictive value of perioperative INR for postoperative LEDVT in patients with early cervical cancer was analyzed.Results Since T_(2),TT,PT,and APTT were shortened,plasma FIB and D-D were increased,and INR was decreased in both groups of patients(P<0.05).There was no statistically significant difference in the dynamic changes in TT,PT,and APTT between two groups at different times(P>0.05).The plasma FIB and D-D of LEDVT group at T_(2)-T_(4)time point were higher than those of N-LEDVT group,and the INR was lower than that of N-LEDVT group(P<0.05).The receiver operating characteristic(ROC)curve was drawn.The area under the curve(AUC)of perioperative plasma FIB,D-D and INR predicting the risk of postoperative LEDVT in early cervical cancer patients were 0.681,0.671,and 0.816,respectively.Conclusions INR begin to decline from the first day after surgery in patients with early cervical cancer,which can indicate the risk of postoperative LEDVT.

关 键 词：早期宫颈癌 改良根治性子宫切除术 下肢深静脉血栓 凝血酶原时间国际标准化比值 

分 类 号：R711[医药卫生—妇产科学]