凝血指标对肺癌化疗疗效及预后的临床意义

发布时间：2018-02-09 08:56

本文关键词： 肺癌凝血指标化疗预后因素数学模型　出处：《第四军医大学》2016年硕士论文　论文类型：学位论文

【摘要】：研究目的:通过比较肺癌患者与健康体检者之间的凝血相关指标的差异以及凝血相关指标与化疗疗效之间的关系,分析肺癌患者预后的相关影响因素,建立风险预测模型,评价凝血相关指标在肺癌治疗与预后的临床意义。研究方法:采用回顾性研究的方法,收集自2010年1月至2013年1月期间在西京医院住院的肺癌患者,共165例。所有的肺癌患者均经纤维支气管镜或手术方式获得病理确诊。记录患者的年龄、性别、肺癌临床分期、肿瘤病理类型、伴随疾病及凝血指标等。同时,收集同时间的健康体检者的相关临床资料(性别、年龄、凝血功能、血常规)进行相关统计学分析。1.了解肺癌患者凝血指标与健康体检者之间的差别;2.了解肺癌患者的凝血指标与肿瘤临床病理及与肿瘤化疗疗效之间的关系;3.分析影响肺癌患者预后的可能因素并建立预测预后风险的数学模型。研究结果:1.肺癌组与健康体检组相比较,血浆血小板、纤维蛋白原、D-二聚体水平明显增高,TT时间延长(P0.05)。2.与非小细胞肺癌患者相比,血浆D-二聚体水平在小细胞肺癌患者中明显增高;分期晚的肺癌患者与分期早的相比较,血浆纤维蛋白原、D-二聚体水平高,其中,有淋巴结转移的患者与无淋巴结转移的肺癌患者相比,纤维蛋白原、D-二聚体水平高。3.化疗后有效组血浆的D-二聚体、纤维蛋白原以及血小板水平降低,无效组则未发生明显变化。4.单因素生存分析发现:肺癌患者的淋巴结转移情况、分期、癌胚抗原、D-二聚体、血小板水平为影响其预后的因素,其中独立预后因素为分期及D-二聚体水平。结论:肺癌患者普遍存在高凝状态,同时患者的疾病分期情况、淋巴结转移以及化疗疗效与凝血指标的变化密切相关。各因素中,疾病分期、淋巴结转移、癌胚抗原、纤维蛋白原、D-二聚体水平为影响肺癌患者预后的因素,其中疾病分期及D-二聚体水平为肺癌患者的独立预后因素。本研究建立的以预后指数为变量的风险预后模型对肺癌患者的预后具有一定的个体化预测作用。
[Abstract]:Objective: to analyze the prognostic factors of lung cancer patients and establish a risk prediction model by comparing the difference of coagulation related indexes between lung cancer patients and healthy people and the relationship between coagulation related indexes and chemotherapy efficacy. To evaluate the clinical significance of coagulation-related indexes in the treatment and prognosis of lung cancer. Methods: retrospective study was used to collect lung cancer patients hospitalized in Xijing Hospital from January 2010 to January 2013. A total of 165 patients with lung cancer were diagnosed by fiberoptic bronchoscopy or surgery. The age, sex, clinical stage of lung cancer, tumor pathological type, associated disease and coagulation index were recorded. Collect the relevant clinical data (sex, age, coagulation function) of the same time health examiners, To understand the difference between the coagulation index of lung cancer patients and the healthy people 2. To understand the relationship between the coagulation index of lung cancer patients and the clinicopathology of tumor and the curative effect of tumor chemotherapy. The possible factors influencing the prognosis of lung cancer patients and establishing a mathematical model to predict the prognostic risk. The plasma platelet and fibrinogen D-dimer levels were significantly increased in patients with small cell lung cancer (SCLC) than in patients with non-small cell lung cancer (NSCLC). Plasma fibrinogen D-dimer levels were higher in patients with late stage lung cancer than in patients with early stage, in which patients with lymph node metastasis were compared with lung cancer patients without lymph node metastasis. The plasma levels of D-dimer, fibrinogen and platelets in the effective group after chemotherapy decreased, while the level of fibrinogen and platelets did not change significantly in the ineffective group. The univariate survival analysis showed that the lymph node metastasis of lung cancer patients. Stage, carcinoembryonic antigen D-dimer, platelet level are the factors influencing prognosis, and independent prognostic factors are staging and D-dimer level. Conclusion: high coagulability is common in patients with lung cancer, and disease staging is common in patients with lung cancer. Lymph node metastasis and chemotherapeutic efficacy were closely related to the changes of coagulation parameters. Among the factors, stage of disease, lymph node metastasis, carcinoembryonic antigen, fibrinogen D-dimer level were the factors influencing the prognosis of lung cancer patients. The disease stage and D-dimer level are independent prognostic factors of lung cancer patients. The risk prognostic model based on prognostic index has a certain individualized predictive effect on the prognosis of lung cancer patients.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R734.2

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