原发性肝癌的临床分期与凝血指标的相关性分析

发布时间：2018-04-28 16:15

本文选题：肝癌 + 凝血　；参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的收集肝癌患者的凝血四项(TT、PT、APTT、FIB)、D-二聚体及血小板参数(PLT、MPV、PDW)的变化规律,进一步分析上述指标与肝癌临床分期的相关性,探索联合检测上述指标对肝癌患者预后的临床意义。方法收集并整理2014年9月至2016年9月宁夏医科大学总医院各科室收住的确诊为肝癌患者135例、肝硬化患者40例,选择同期健康体检人员50例作为对照组,分别收集研究对象的TT、PT、APTT、FIB、D-D、PLT、MPV、PDW;同时收集肝癌患者的一般状态、肿瘤状态(直径、数量、血管侵犯情况)、肝功能状态(白蛋白、血清总胆红素、腹水、肝性脑病、门静脉高压),按照2005年美国肝脏疾病研究协会修改后的巴塞罗那临床肝癌分期标准,分为a、b、c、d四期并入相对应的A、B、C、D四个亚组。统计分析225例研究对象的一般临床特征;统计分析肝癌患者、肝硬化患者凝血相关指标的表达水平;统计分析肝癌患者临床分期与凝血指标是否存在相关性。结果1.225例研究对象的一般临床特征无统计学差异。2.对照组与LC组、HCC组的TT、PT、APTT、FIB、D-D、PLT、MPV和PDW比较,差异有统计学意义(P均0.05);LC组的APTT、FIB、PLT与HCC组比较,差异有统计学意义(P均0.05),LC组的TT、PT、D-D、MPV、PDW与HCC组比较,差异无统计学意义(P均0.05)。3.肝癌A、B、C、D四组之间TT、PT、APTT、FIB、D-D、PLT的比较,差异有统计学意义(P均0.05);MPV和PDW的比较,差异无统计学差异(P均0.05)。4.采用Spearman相关性分析,对HCC组的TT、PT、APTT、FIB、D-D、PLT、MPV、PDW与BCLC进行相关性分析,TT、PT、APTT、D-D与BCLC呈正相关(rTT=0.860,rPT=0.942,rAPTT=0.640,rD-D=0.898,P均0.05),FIB、PLT与BCLC呈负相关(rFIB=-0.303,rPLT=-0.736,P均0.05);MPV、PDW与BCLC无相关性(P均0.05)。结论不同分期的肝癌患者凝血相关指标表达水平不同,联合检测TT、PT、APTT、FIB、D-D、PLT、MPV和PDW的变化水平,可较准确反应体内止凝血系统状态,一定程度上反应肝癌患者的病情变化,能为肝癌患者的病情预后及治疗提供一定的参考价值。
[Abstract]:Objective to study the relationship between the above indexes and the clinical stages of liver cancer by collecting the changes of D-dimer and platelet parameters (PLTT) and MPV / PDW in the patients with hepatocellular carcinoma (HCC), and to explore the clinical significance of the combined detection of the above indexes in the prognosis of patients with hepatocellular carcinoma (HCC). Methods from September 2014 to September 2016, 135 patients with liver cancer and 40 patients with liver cirrhosis were collected from the General Hospital of Ningxia Medical University, and 50 healthy persons were selected as control group. The patients' general state, tumor status (diameter, quantity, vascular invasion), hepatic function (albumin, serum total bilirubin, ascites, hepatic encephalopathy) were collected. Portal hypertension was divided into four subgroups of AHBC D according to the Barcelona clinical liver cancer staging standard modified by the American Association for the study of liver Diseases (AHA) in 2005. The general clinical characteristics of 225 patients were analyzed statistically. The expression levels of coagulation related indexes in patients with liver cancer and cirrhosis were analyzed statistically. Whether there was correlation between clinical stages and coagulation indexes in patients with liver cancer was statistically analyzed. Results there was no statistical difference in general clinical characteristics of 1.225 cases. 2. 2. There were significant differences between the control group and the LC group (P < 0.05). The difference between the two groups was statistically significant (P < 0.05). There was no significant difference between the control group and the LC group (P < 0.05). There was no significant difference between the HCC group and the control group (P < 0.05), but there was no significant difference between the two groups (P < 0.05). There was a significant difference between the four groups (P < 0.05) and PDW (P < 0.05), and there was no significant difference (P = 0.05, P = 0.05, P = 0.05, P = 0.05), and the difference was not significant (P > 0.05), but there was no significant difference between the four groups (P > 0.05). Using Spearman correlation analysis, the correlation analysis between HCC group and BCLC was carried out. There was a positive correlation between BCLC and BCLC. There was no correlation between BCLC and BCLC. The correlation between BCLC and BCLC was 0.05%. There was no correlation between BCLC and BCLC. There was a negative correlation between BCLC and BCLC. The correlation between BCLC and BCLC was negative correlation between PTT and BCLC (r FIB-0.303rPLTn- 0.736P) and no correlation between BCLC and PTT (0.303rPLT-0.736P). The correlation between BCLC and PTT was not significant (P > 0.05), and the correlation between BCLC and BCLC was not significant (P > 0.05). The correlation between BCLC and BCLC was negative correlation between BCLC and PTT (0.303rPLTn- 0.736P). The correlation between PTD-D and BCLC was not significant. Conclusion there are different expression levels of coagulation related indexes in patients with liver cancer at different stages. The combined detection of MPV and PDW in PTPTAPTT-FIBTX D-DITT can accurately reflect the state of blood coagulation system in vivo, and to some extent reflect the changes of state of disease in patients with liver cancer. It can provide some reference value for prognosis and treatment of liver cancer patients.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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