血浆纤维蛋白原水平同胃癌肝转移临床病理参数的关系和预测疗效及预后的价值

发布时间：2018-03-09 00:26

本文选题：胃癌　切入点：肝转移　出处：《河北医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:我国胃癌发病率高,分别居男性第2位、女性第3位,且易于早期发生肝转移,预后差。前期研究表明,胃癌根治术前存在高纤维蛋白原血症可预测疾病分期晚、肿瘤浸润程度深、淋巴结转移及病变范围广,并影响患者总生存。国内目前尚缺乏血浆纤维蛋白原水平与胃癌肝转移的相关研究。本文主要探究初诊即存在肝转移的胃癌患者血浆纤维蛋白原水平与临床病理参数的关系,及治疗前后血浆纤维蛋白原水平的变化与预测疗效的价值并预测预后,为临床治疗提供参考。方法:搜集2010年1月至2014年12月间于河北医科大学第四医院普通外科就诊的胃恶性肿瘤患者的住院病历资料及随访数据。患者统一于治疗前1周内行血常规、肝肾功能、凝血功能及胃癌肿瘤标志物检测,并由我院检验科统一出具相关实验室检查结果。应用SPSS13.0统计软件进行数据分析,探究纤维蛋白原与胃癌肝转移临床病理参数的关系和预测疗效及预后的价值。结果:1共437例胃癌患者符合入组条件进入本研究,其中分期早、接受胃癌根治术者248例,初诊即合并肝转移且无手术机会者189例。早期胃癌患者其血浆平均纤维蛋白原水平为3.28±1.06g/L;肝转移患者血浆纤维蛋白原平均水平为3.70±1.02g/L,T检验得出初诊即存在肝转移的Ⅳ期患者其血浆纤维蛋白原水平显著高于可行根治性术的早期患者。进一步统计学分析表明,肝转移患者中高纤维蛋白原血症的发生率明显高于早期患者(20.63%vs.8.87%;P0.001)。2进一步统计学分析显示,当发生胃癌肝转移时,在全身感染性指标—PLT(P=0.001)、白蛋白水平(P=0.010)及PLR评分(P=0.018)水平升高的患者中血浆纤维蛋白原水平较高。且在老年患者中,血浆纤维蛋白原水平亦有升高趋势,但与性别及肿瘤在胃内生长部位等方面无关(P0.05)。此外,虽然肝脏内转移病灶个数及肝功能情况对血浆纤维蛋白原水平均有一定影响,但两者均无统计学意义(P0.05)。而在除肝脏以外合并其他脏器转移、存在腹腔或远处淋巴结转移的患者中,其血浆纤维蛋白原水平明显升高(P0.05),对疾病分期晚有进一步提示意义。但与胃癌肿瘤标志物—CEA(P=0.710)、CA19-9(P=0.450)、CA72-4(P=0.40)、CA50(P=0.631)水平均无关。3在189例胃癌肝转移患者中共51例患者收集到疗效数据,其中治疗缓解者(PR者)17例,未缓解者(SD+PD者)34例,无CR患者。在治疗缓解者中,治疗后血浆纤维蛋白原水平下降明显,存在统计学差异(P=0.011);而在未缓解者中,治疗前后血浆纤维蛋白原水平差异不显著(P=0.476),但血浆纤维蛋白原水平有升高趋势。4在初诊即存在肝转移的胃癌患者中,治疗前即存在高纤维蛋白原血症的39例患者中死亡30例,死亡率为76.92%,在150例血浆纤维蛋白原水平正常的患者中死亡119例,死亡率为79.33%,统计学示二者无显著差别(P0.05)。进一步生存分析显示,二者生存率无显著统计学差异(Log-Rank test;P=0.829),但存在高纤维蛋白原血症的患者其总生存期(OS)有下降趋势,提示临床预后差。结论:本研究提示,胃癌肝转移患者其血浆纤维蛋白原水平较可行根治术的早期患者显著升高,且与全身感染性指标等多种临床病理因素密切相关,可作为一个敏感的血液学指标提示患者治疗效果及预测患者不良预后,对临床工作来说经济、简单实用,可为患者带来较大裨益。
[Abstract]:Objective: the incidence of gastric cancer in China, ranked second in men, third women, and easy early metastasis, poor prognosis. Early studies show that gastric cancer preoperative high fibrinogen can predict disease stage, degree of tumor infiltration depth, lymph node metastasis and lesion range, and influence overall survival. There is lack of related research of plasma fibrinogen level and hepatic metastasis of gastric cancer. This paper mainly explores the relationship that is newly diagnosed with liver metastasis in patients with gastric cancer plasma fibrinogen levels and clinicopathological parameters, the changes of plasma fibrinogen level and predict the efficacy and value before and after treatment and predict prognosis, provide the reference for the clinical treatment. Methods: to collect medical records and follow-up the number of gastric malignant tumor patients from January 2010 to December 2014 in the treatment of general surgery of the fourth hospital of Hebei Medical University According to the patients. United in the first 1 weeks of treatment. Blood routine, liver and kidney function, blood coagulation function and gastric cancer tumor markers, and by our hospital unified issued by the relevant laboratory examination results. SPSS13.0 statistical software was used for data analysis, explore the fibrinogen and gastric cancer liver metastasis and clinical pathological parameters of the relationship between the curative effect and prognosis prediction the value of 1. Results: a total of 437 cases of patients with gastric cancer were eligible to enter the study, of which 248 cases underwent early stage, radical resection of gastric cancer, diagnosed with hepatic metastasis in 189 cases and no chance of surgery. Patients with early gastric cancer the average plasma fibrinogen level was 3.28 + 1.06g/L; liver metastasis plasma fibrinogen with the original average of 3.70 + 1.02g/L, T test showed that newly diagnosed liver metastases in stage IV patients with plasma fibrinogen levels were significantly higher in patients with early postoperative radical feasible. Further system Statistical analysis showed that liver metastasis in patients with high fibrin fibrinogen was significantly higher than that in patients with early stage (20.63%vs.8.87%; P0.001).2 further statistical analysis showed that, when the occurrence of liver metastasis of gastric cancer, the index of PLT infection (P=0.001), albumin (P=0.010) and PLR score (P=0.018) higher plasma fibrinogen fibrinogen levels in patients with elevated levels. And in elderly patients, the plasma fibrinogen level also increased, but the growth location and gender and tumor in the stomach not (P0.05). In addition, although the number of lesions and liver function has a certain effect on the average plasma fibrinogen of liver metastasis, but there was no statistically significant between the two (P0.05). And in addition to outside of the liver and other organ metastasis, abdominal or distant lymph node metastasis of the patients, the plasma fibrinogen level was significantly increased (P0.05), In late stage of disease have further implications. But the markers of CEA and gastric cancer (P=0.710), CA19-9 (P=0.450), CA72-4 (P=0.40), CA50 (P=0.631) levels were independent of.3 in 189 cases of liver metastasis from gastric cancer patients including 51 patients were collected in treatment efficacy data, corrosion solution (PR) in 17 cases, no remission (SD+PD) 34 cases, non CR patients. In the treatment of remission after treatment, plasma fibrinogen levels decreased significantly, there was significant difference (P=0.011); while in remission, the difference of plasma fibrinogen levels before and after treatment was not significant (P=0.476), but the plasma. Protein level increased in newly diagnosed.4 is liver metastasis of gastric cancer, 30 cases of death in 39 cases before the treatment of fibrinogen in patients, the mortality rate was 76.92%, 119 cases of death in 150 cases of patients with normal plasma fibrinogen level, the mortality rate was 79.33%, Statistics showed no significant difference between the two (P0.05). The survival analysis showed that the survival rate of two, there was no statistically significant difference (Log-Rank test; P=0.829), but the presence of fibrinogen in patients with overall survival (OS) decreased, suggesting that poor clinical prognosis. Conclusion: This study suggests that the gastric cancer patients with liver metastasis of the plasma fibrinogen level is feasible in patients with early radical resection was significantly increased, which is closely related with the index and other clinical pathological factors of systemic infection, can be used as a sensitive indicator of poor prognosis of patients with hematological patients and prediction on clinical work is economic, simple and practical, can bring great the benefit for patients.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.2

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