联合凝血功能指标在结直肠癌患者化疗后高凝状态监测中的应用价值  

Application value of combined coagulation function indicators in monitoring hypercoagulable state of patients with colorectal cancer after chemotherapy

作　　者：陆悦 卢仁泉 张杰 郑慧 LU Yue;LU Renquan;ZHANG Jie;ZHENG Hui(Department of Clinical Laboratory,Fudan University Shanghai Cancer Center/Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院检验科,复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国癌症杂志》2024年第3期278-285,共8页China Oncology

摘　　要：背景与目的:常规凝血实验(conventional coagulation test,CCT)检测所用的血浆仅能够反映某个凝血时间点/段的单一成分,而血栓弹力图(thromboelastography,TEG)检测能够描绘凝血及纤维蛋白溶解的整体动态过程的曲线,更能独立完整地反映血液的真实状态,可作为凝血功能检测的补充。本研究旨在评估联合凝血功能指标在结直肠癌患者化疗后高凝状态监测中的应用价值,探讨结直肠癌患者化疗后血栓形成的危险因素,为临床监测高凝状态提供参考。方法:选取复旦大学附属肿瘤医院2021年6月—2023年6月收治的160例结直肠癌患者作为实验组,并选取同期的80名健康体检者作为对照组,再将实验组以是否合并血栓分为未合并血栓组(82例)和合并血栓组(78例)。研究3组对象的TEG[包括凝血反应时间(coagulation reaction time,R)、凝血形成时间(coagulation formation time,K)、血细胞凝块形成速率(blood clot formation rate,Angle)、血栓最大振幅(maximum amplitude,MA)和凝血综合指数(coagulation index,CI)]、CCT[包括活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶原时间(prothrombin time,PT)、凝血酶时间(thrombin time,TT)、纤维蛋白原(fibrinogen,Fib)、D-二聚体(D-dimer,DD)和纤维蛋白原降解产物(fibrinogen degradation products,FDP)]及血小板计数(platelet count,PLT)的差异。以是否合并血栓作为高凝状态的标准,选择其中差异有统计学意义的指标纳入二元logistic回归分析,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线,分析单独及联合检测凝血功能指标对结直肠癌患者化疗后高凝状态的诊断效能。收集160例结直肠癌患者的基础信息、肿瘤分期和深静脉血栓Autar评估量表,进行logistic回归分析,探索血栓形成的危险因素。本研究经复旦大学附属肿瘤医院伦理委员会审核通过(编号:050432-4-2108*)。结果:与对照组相比,未合Background and purpose:The plasma used for routine coagulation test(CCT)can only reflect a single component at a certain coagulation time point/segment,while thromboelastography(TEG)can depict the overall dynamic process curve of coagulation and fibrinolysis,which can more independently and completely reflect the true state of the blood and can serve as a supplement to coagulation function testing.This study aimed to evaluate the application value of combined coagulation function indexes in monitoring the hypercoagulable state of patients with colorectal cancer after chemotherapy,and to explore the risk factors of thrombosis in patients with colorectal cancer after chemotherapy,so as to provide reference for clinical monitoring of hypercoagulable state.Methods:A total of 160 patients with colorectal cancer from Fudan University Shanghai Cancer Center from June 2021 to June 2023 were selected as the experimental group,and 80 healthy subjects were selected as the control group.Then the experimental group was divided into a group without thrombosis(82 cases)and a group with thrombosis(78 cases)according to whether they had thrombosis or not.The determinations of thromboelastography(TEG)[coagulation reaction time(R),coagulation formation time(K),blood clot formation rate(α-Angle),maximum amplitude(MA)and coagulation index(CI)],conventional coagulation tests(CCT)[activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen(Fib),D-dimer(DD),fibrinogen degradation products(FDP)]and platelet count(PLT)were studied among three groups.With or without thrombosis as the criterion of hypercoagulable state,statistically significant indicators were selected to be included in the binary logistic regression analysis,and the receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of single and combined detection of the coagulation function indicators for hypercoagulable state in patients with colorectal cancer after chemotherapy.Basic information,tumor stage and Au

关 键 词：结直肠癌 化疗 血栓弹力图 常规凝血实验 血栓 

分 类 号：R735.3[医药卫生—肿瘤]