老年肺癌手术患者凝血状态和血小板参数的变化及意义
摘要
目的探讨行手术治疗的老年肺癌患者循环血液中凝血状态和血小板参数的变化及临床意义。方法确诊为非小细胞肺癌并手术治疗的40例老年患者作为肺癌组,40例健康体检者作为对照组。于手术前后行血栓弹力图、血常规、传统凝血检测。对各项检测指标进行统计学分析。结果两组相比纤维蛋白原(FIB)有统计学意义(P<0. 05)。与对照组比较,肺癌组手术前后反应时间(R)、血小板分布宽度(PDW)、血小板平均体积(MPV)值均变小,α角(Angle)和凝血综合指数(CI)值变大,差异有统计学意义(P<0. 05);术前血小板计数(PLT)与对照组和术后相比均明显增多;手术前后K值均小于对照组,仅术后差异有统计学意义(P<0. 05)。有淋巴结转移者与对照组血栓弹力图(TEG)各值差异有统计学意义,较无淋巴结转移者MA值明显变大(P<0. 05)。结论老年肺癌患者血液呈高凝状态、血小板数量增多和功能增强,有淋巴结转移者更明显。手术切除肿瘤能抑制血小板增多。
引文
1支修益,石远凯,于金明.中国原发性肺癌诊疗规范(2015年版)[J].中华肿瘤杂志,2015;37(1):67-78.
2 Zhao J,Zhao M,Jin B,et al.Tumor response and survival in patients with advanced non-small-cell lung cancer:the predictive value of chemotherapy-induced changes in fibrinogen[J].BMC Cancer,2012;12(9):330.
3 Tas F,Kilic L,Serilmez M,et al.Clinical and prognostic significance of coagulation assays in lung cancer[J].Respir Med,2013;107(3):451-7.
4 Kim KH.Prognostic significance of initial platelet counts and fibrinogen level in advanced non-small cell lung cancer[J].J Korean Med Sci,2014;29(4):507-11.
5 Tormoen GW,Haley KM,Levine RL,et al.Do circulating tumor cells play a role in coagulation and thrombosis[J]?Front Oncol,2012;2:115.
6 Tomita M,Shimizu T,Ayabe T,et al.Prognostic significance of the combined use of preoperative platelet count and serum carcinoembryonic antigen level in non-small-cell lung cancer[J].Gen Thorac Cardiovasc Surg,2010;58(11):573-6.
7周文杰,朱丽娜,鲁露,等.肺癌伴血小板增多患者的临床病理特征及与预后的关系[J].现代中西医结合杂志,2015;24(36):529-30.
8郭旭利.组织因子和活化的血小板在肺癌中的研究进展[J].医学综述,2012;18(1):47-50.
9 Sankarankutty A,Nascimento B,Teodoroda Luz L,et al.TEG and ROTEM in trauma:similar test but different results[J].World J Emerg Surg,2012;7(suppl 1):3-5.
10 Levy JH,Dutton RP,Hemphill JC 3rd,et al.Multidisciplinary approach to the challenge of hemostasis[J].Anesth Analg,2010;110(2):354-64.
11 Martini WZ,Cortez DS,Dubick MA,et al.Thromboelastography is better than PT,a PTT,and activated clotting time in detecting clinically relevant clotting abnormalities after hypothermia,hemorrhagic shock and resuscitation in pigs[J].J Trauma,2008;65(3):535-43.
12 Park MS,Martini WZ,Dubick MA,et al.Thromboelastography as a better indicator of hypercoagulable state after injury than prothrombin time or activated partial thromboplastin time[J].J Trauma,2009;67(2):266-75.
13 Papa ML,Capasso F,Pudore L,et al.Thromboelastographic profiles as a tool for thrombotic risk in digestive tact cancer[J].Exp Oncol,2007;29(2):111-5.
14李承慧,段爱雄,汪志求,等.非小细胞肺癌患者血小板增多与预后关系的临床研究[J].现代肿瘤医学,2014;22(2):329-31.
15 Maráz A,Furák J,Varga Z,et al.Thrombocytosis has a negative prognostic value in lung cancer[J].Anticancer Res,2013;33(4):1725-9.
16张丽娟,黄勇,胡长路.非小细胞肺癌患者高血小板血症与预后关系的分析[J].中国临床保健杂志,2014;17(5):529-30.
17曾小飞,邓波,王如文,等.血栓弹力图评估肺癌患者围手术期凝血状态的临床研究[J].第三军医大学学报,2016;38(7):766-70.
18 Anderson JA,Weitz JI.Hypercoagulable states[J].Crit Care Clin,2011;27(4):933-52.
2 Zhao J,Zhao M,Jin B,et al.Tumor response and survival in patients with advanced non-small-cell lung cancer:the predictive value of chemotherapy-induced changes in fibrinogen[J].BMC Cancer,2012;12(9):330.
3 Tas F,Kilic L,Serilmez M,et al.Clinical and prognostic significance of coagulation assays in lung cancer[J].Respir Med,2013;107(3):451-7.
4 Kim KH.Prognostic significance of initial platelet counts and fibrinogen level in advanced non-small cell lung cancer[J].J Korean Med Sci,2014;29(4):507-11.
5 Tormoen GW,Haley KM,Levine RL,et al.Do circulating tumor cells play a role in coagulation and thrombosis[J]?Front Oncol,2012;2:115.
6 Tomita M,Shimizu T,Ayabe T,et al.Prognostic significance of the combined use of preoperative platelet count and serum carcinoembryonic antigen level in non-small-cell lung cancer[J].Gen Thorac Cardiovasc Surg,2010;58(11):573-6.
7周文杰,朱丽娜,鲁露,等.肺癌伴血小板增多患者的临床病理特征及与预后的关系[J].现代中西医结合杂志,2015;24(36):529-30.
8郭旭利.组织因子和活化的血小板在肺癌中的研究进展[J].医学综述,2012;18(1):47-50.
9 Sankarankutty A,Nascimento B,Teodoroda Luz L,et al.TEG and ROTEM in trauma:similar test but different results[J].World J Emerg Surg,2012;7(suppl 1):3-5.
10 Levy JH,Dutton RP,Hemphill JC 3rd,et al.Multidisciplinary approach to the challenge of hemostasis[J].Anesth Analg,2010;110(2):354-64.
11 Martini WZ,Cortez DS,Dubick MA,et al.Thromboelastography is better than PT,a PTT,and activated clotting time in detecting clinically relevant clotting abnormalities after hypothermia,hemorrhagic shock and resuscitation in pigs[J].J Trauma,2008;65(3):535-43.
12 Park MS,Martini WZ,Dubick MA,et al.Thromboelastography as a better indicator of hypercoagulable state after injury than prothrombin time or activated partial thromboplastin time[J].J Trauma,2009;67(2):266-75.
13 Papa ML,Capasso F,Pudore L,et al.Thromboelastographic profiles as a tool for thrombotic risk in digestive tact cancer[J].Exp Oncol,2007;29(2):111-5.
14李承慧,段爱雄,汪志求,等.非小细胞肺癌患者血小板增多与预后关系的临床研究[J].现代肿瘤医学,2014;22(2):329-31.
15 Maráz A,Furák J,Varga Z,et al.Thrombocytosis has a negative prognostic value in lung cancer[J].Anticancer Res,2013;33(4):1725-9.
16张丽娟,黄勇,胡长路.非小细胞肺癌患者高血小板血症与预后关系的分析[J].中国临床保健杂志,2014;17(5):529-30.
17曾小飞,邓波,王如文,等.血栓弹力图评估肺癌患者围手术期凝血状态的临床研究[J].第三军医大学学报,2016;38(7):766-70.
18 Anderson JA,Weitz JI.Hypercoagulable states[J].Crit Care Clin,2011;27(4):933-52.