术前凝血功能指标在原发性肝癌患者诊断及预后判断中的应用

发布时间：2018-03-06 03:05

本文选题：凝血酶原时间　切入点：国际标准化比值　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:凝血功能检测是临床最常见的检查项目之一,其目的是了解患者凝血功能情况,防止有创的检查或处理时由于止血功能差而使病人发生危险。凝血酶原时间延长情况也是能否进行外科手术的判断标准之一。凝血功能检测主要包括凝血酶原时间、国际标准化比值、纤维蛋白原等检测项目。血小板计数作为血常规的检测项目,也是重要的反映凝血功能的指标。由于大多数的酶及凝血因子在肝细胞合成,多种肝病患者凝血功能异常,如在肝硬化患者中凝血酶原时间延长,国际标准化比值升高,血小板数量减少,在肝癌患者中纤维蛋白原含量升高等。因此上述能够反映凝血功能的指标有作为肝硬化及肝癌诊断指标及预后情况判断指标的价值。方法:本研究共收集5079例符合纳入标准的肝病患者。其中613例为在河南省肿瘤医院接受根治性肝切除手术并具有5年随访信息的原发性肝癌患者,4466例在解放军302医院就诊的肝炎、肝纤维化、肝硬化、肝癌患者。这4466例患者中包括544例具有肝穿及病理学诊断信息的肝纤维化或肝硬化患者,3922例肝炎、肝硬化、肝癌患者。使用t检验及单因素方差分析获得凝血功能指标在不同背景,不同纤维化程度患者中的情况,使用Kaplan-Meier及Cox进行生存分析,确定术前凝血功能指标作为原发性肝癌患者术后预后指标的价值。使用Western-Blot实验验证纤维蛋白原在癌与癌旁组织中的表达情况。结果:通过单因素方差分析发现随着纤维化等级的升高凝血酶原时间及国际标准化比值逐渐升高,血小板计数逐渐下降,纤维蛋白原无明显的变化趋势。通过比较临床检测指标在肝炎、肝硬化及肝癌患者中的变化趋势可发现,肝功能指标如白蛋白,前白蛋白在肝炎患者中较高,肝癌患者其次,肝硬化患者最差。纤维蛋白原变化趋势与这些指标有所不同,在肝癌患者中最高,如在HBV相关的肝炎、肝硬化及肝癌患者中分别为2.41g/L、2.17 g/L、3.43 g/L。纤维蛋白原可作为乙肝相关原发性肝癌及无病毒感染原发性肝癌患者的预警诊断指标,ROC曲线下面积及95%可信区间分别为0.790(0.751,0.785)、0.807(0.770,0.826),纤维蛋白原可以作为肝癌诊断指标的主要原因与其在肝癌患者中代谢异常有关。通过多因素生存分析显示术前国际标准化比值、纤维蛋白原是乙肝相关原发性肝癌的独立预后因素,其HR及95%可信区间分别是1.826(1.192,2.799)、1.234(1.023,1.488)术前国际标准化比值是无病毒感染背景原发性肝癌患者的独立预后因素HR及95%可信区间为15.972(2.510,101.654)。结论:肝癌患者术前凝血功能指标,凝血酶原时间、国际标准化比值、纤维蛋白原可作为指示肝癌患者术后预后的因子,其中国际标准化比值、纤维蛋白原是独立的预后因素。纤维蛋白原还可作为HBV感染背景及无病毒感染背景的原发性肝癌患者的诊断指标。
[Abstract]:Background: coagulation function test is one of the most common clinical examination items, the purpose of which is to understand the coagulation function of patients. The prothrombin time prolongation is also one of the criteria for judging whether or not surgery can be carried out. The coagulation function test mainly includes prothrombin time. International standardized ratio, fibrinogen and other tests. Platelet count is an important indicator of coagulation function as well as blood routine. Because most of the enzymes and coagulation factors are synthesized in hepatocytes, Many patients with liver diseases have abnormal coagulation function, such as prolonged prothrombin time, increased international standardized ratio and reduced platelet count in patients with liver cirrhosis. Therefore, the above indexes which can reflect coagulation function have the value as diagnostic index and prognostic index of liver cirrhosis and liver cancer. Methods: a total of 5079 cases were collected in this study. Among them, 613 cases were patients with primary liver cancer undergoing radical hepatectomy in Henan Cancer Hospital and had 5-year follow-up information. There were 4466 cases of hepatitis in 302 Hospital of PLA. Liver fibrosis, liver cirrhosis, liver cancer. These 4466 patients include 544 patients with liver fibrosis or cirrhosis with information of liver puncture and pathological diagnosis, 3922 patients with hepatitis, liver cirrhosis, T test and single factor variance analysis were used to obtain coagulation function indexes in patients with different background and degree of fibrosis. Kaplan-Meier and Cox were used for survival analysis. To determine the value of preoperative coagulation function as a prognostic index in patients with primary liver cancer. To verify the expression of fibrinogen in cancer and paracancerous tissues by Western-Blot test. Results: univariate analysis of variance showed that the expression of fibrinogen was associated with that of HCC. The prothrombin time and the international standardized ratio increased gradually with the increase of fibrosis grade. The platelet count decreased gradually, but fibrinogen showed no obvious change. By comparing the changes of clinical indicators in patients with hepatitis, liver cirrhosis and liver cancer, we found that liver function indicators such as albumin, Prealbumin was higher in hepatitis patients, followed by liver cancer patients, and liver cirrhosis patients. The change trend of fibrinogen was different from these indexes, and it was the highest in liver cancer patients, such as hepatitis associated with HBV. In patients with liver cirrhosis and liver cancer, 2.41 g / L of 2.17 g / L of 2.17 g / L and 3.43 g / L. Fibrinogen can be used as an early warning diagnostic index for patients with Hepatitis B associated primary liver cancer and primary liver cancer without virus infection. The area under the curve and the 95% confidence interval under the curve are 0.790 ~ 0.751g / L ~ 0.785g / L ~ 0.8070.7700.826A, respectively. The main reason that proto can be used as diagnostic index of liver cancer is related to abnormal metabolism in patients with liver cancer. Fibrinogen is an independent prognostic factor of Hepatitis B associated primary liver cancer. The HR and 95% confidence intervals were 1.826 / 1.192 / 2.799 / 1.234 / 1.02323 / 1.488 respectively. The HR and 95% confidence intervals of patients with primary liver cancer without virus infection background were 15.972n2.510101.6540.Conclusion: the preoperative coagulation function index, prothrombin time, prothrombin time, and so on. International standardized ratio, fibrinogen can be used as a prognostic indicator of patients with liver cancer, in which the international standardized ratio, Fibrinogen is an independent prognostic factor. Fibrinogen can also be used as a diagnostic marker for patients with primary liver cancer with or without HBV infection background.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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