肺癌患者静脉血栓相关因素分析及其与预后的关系

发布时间：2018-05-02 10:18

本文选题：恶性肿瘤 + 凝血指标　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景恶性肿瘤的发病率与死亡率逐年上升,尤其是肺癌,其发病率位于世界第一位。大量研究证实,恶性肿瘤远处转移和血栓形成是其死亡的两大主要原因。2015年美国临床肿瘤学会(American Society of Clinical Oncology,ASCO)临床指南建议,肺癌、胃癌等患者在住院治疗期间均应该监测凝血功能变化,定期评估血栓形成的风险,对于高危患者可预防性抗凝治疗,可延长患者的生存期、提高生活质量。目前多数临床医生对恶性肿瘤合并血栓的现象尚未引起足够的重视,影响了患者的生存质量,缩短了患者的生存时间。目的探讨肺癌患者凝血指标的变化,发现肺癌患者发生血栓的相关因素,分析血栓形成与肺癌患者预后的关系。方法回顾性分析2015年1月1日至2016年12月31日就诊于解放军第一五二中心医院的316例肺癌患者和254例健康体检者的凝血指标。样本的总体情况:2015年1月至2016年12月就诊于解放军第一五二中心医院的316例肺癌患者,其中男性205例,女性111例;年龄在35-85岁之间,平均65.49±12.01;肺癌组按血小板计数是否升高分为:血小板升高组85例(26.9%),血小板计数正常组231例(73.1%);按D-二聚体是否升高分为:D-二聚体升高组222例(70.3%),D-二聚体正常组94例(29.7%);按病理类型进行分组:腺癌127例(40.2%),鳞癌101例(32.0%),小细胞肺癌88例(27.8%);按肿瘤临床分期分为I~II期组与III~IV期组,I~II期组85人(26.9%),III~IV期组231人(73.1%);对照组为2015年1月至2016年12月在我院体检的健康人群254人,其中男性145例,女性109例;年龄范围在35-84岁,平均63.17±10.14岁。通过我院病例系统统计对象的临床资料,包括血小板(Platelet,PLT)、凝血酶时间(Thrombin Time,TT)、活化部分凝血活酶时间(Activated partial thromboplastin time,APTT)、凝血酶原时间(Prothrombin time,PT)、D-二聚体(D-dimer,D-D)、纤维蛋白原(Fibrinogen,FIB)等指标水平以及性别、年龄、肺癌的病理类型、分期(I~II期、III~IV期)。数据应用SPSS 17.0统计软件进行处理,组间对比采用u检验,标准为P0.05有统计学意义,P0.01有显著统计学意义。对本研究中所有肺癌患者进行随访,随访方式主要为电话、门诊及住院等。随访从2015年2月1日开始,截止时间为2017年2月31日,最短随访时间6个月,最长随访时间24个月。随访期间死于其他原因、失访或研究截止时仍生存者,均计为截尾值。采用Logistic回归多因素分析,用Kaplan-Meier法绘制生存曲线;生存率比较采用log-rank检验;多因素生存分析采用COX比例风险回归模型进行分析,P0.05为差异有统计学意义。结果1.肺癌组与对照组健康人群凝血功能异常率的比较:肺癌组患者共316例,凝血功能异常者194例,异常率61.4%;对照组254例,凝血功能异常者46例,异常率18.1%,两者相比,其差别有显著统计学意义(P0.01)。2.肺癌组与对照组各凝血指标的比较:肺癌组患者各凝血指标阳性率均明显升高,与对照组相比,差别有显著统计学意义(P0.01);PLT计数与对照组相比变化不明显,差别无统计学意义(P0.05)。3.肺癌患者血小板、D-二聚体指标水平的VTE分布:血小板计数升高的85例肺癌患者并发静脉血栓12例(14.1%),血小板计数正常的231例肺癌患者并发静脉血栓11例(4.8%),两者之间具有统计学差异(P0.01);D-二聚体水平升高者共222例病人,其中并发静脉血栓20例(9.0%),D-二聚体水平正常者共94例病人,其中并发静脉血栓3例(3.2%),两者之间差异具有统计学意义(P0.01)。4.肺癌患者病理类型与VTE的分布:316例肺癌患者,其中腺癌127例(40.2%),鳞癌101例(32.0%),小细胞肺癌88例(27.8%)。肺腺癌患者中并发静脉血栓13例(10.2%),深静脉血栓12例,肺栓塞1例;肺鳞癌患者中并发静脉血栓6例(5.9%),深静脉血栓5例,肺栓塞1例;肺小细胞癌患者中并发静脉血栓4例(4.5%),均为深静脉血栓;肺腺癌与鳞癌及小细胞肺癌组差异有统计学意义(P0.05),肺鳞癌患者组与小细胞肺癌患者组差异无统计学意义(P0.05)。5.肺癌合并静脉血栓的患者与未合并静脉血栓的患者生存时间的比较:肺癌合并VTE患者中位生存时间为20.5月;肺癌未合并VTE患者中位生存时间为23月。采用Log-rank生存比较对这两组患者进行分析,VTE组生存时间较未合并VTE组短且有统计学差异(P0.01)。6.肺癌患者多因素生存分析:本研究对肺癌患者进行多因素生存分析。分析采用Cox比例风险回归分析,统计结果P值小于0.05的主要变量(包括年龄、TNM分期、PT、APTT、Fib、PLT、D-二聚体)被纳入了分析;TNM III~IV期、D-二聚体显著升高,在统计分析上对总生存有显著的不利影响(P0.01)。结论1.肺癌患者凝血功能异常率较高;2.肺癌合并静脉血栓者的中位生存时间较未合并者短;3.D-二聚体升高与肺癌患者生存时间缩短可能有关。
[Abstract]:The incidence and mortality of malignant tumors are increasing year by year, especially lung cancer, the incidence of which is the first in the world. A large number of studies have confirmed that the two major causes of death are distant metastasis and thrombosis of malignant tumors, the clinical guidelines for the American Society of Clinical Oncology (ASCO) of the American Society of Clinical Oncology (Society of Clinical Oncology), lung cancer, Patients with gastric cancer should monitor the changes of coagulation function during hospitalization, evaluate the risk of thrombus formation regularly, prevent anticoagulant therapy for high-risk patients, prolong the life period and improve the quality of life. At present, most clinicians have not paid enough attention to the combination of malignant tumor and thrombus, and affect the patients. Objective to explore the survival time of the patients. Objective to explore the changes in blood coagulation indexes of lung cancer patients, to find the related factors of the thrombosis in the patients with lung cancer, and to analyze the relationship between the thrombosis and the prognosis of the patients with lung cancer. Methods a retrospective analysis of 316 cases of lung cancer in the first 52 Central Hospital of PLA from January 1, 2015 to December 31, 2016 was analyzed. Blood coagulation indexes of cancer patients and 254 health examiners. The overall situation of the samples: from January 2015 to December 2016, 316 cases of lung cancer were diagnosed in the first 52 Central Hospital of the PLA, including 205 males and 111 females; the average age was 65.49 + 12.01 between 35-85 years old. The lung cancer group was divided into platelets according to the increase of platelet count. Group 85 (26.9%) and 231 cases (73.1%) of platelet count normal group; according to the elevation of D- two polymer: 222 cases (70.3%) and 94 cases (29.7%) in the normal group of D- two, 94 cases of adenocarcinoma (40.2%), squamous cell carcinoma, small cell lung cancer, were divided into I~II stage and III~IV stage according to the clinical stage of tumor. Group I~II was 85 (26.9%) and 231 in phase III~IV (73.1%); in the control group, 254 people were examined in our hospital from January 2015 to December 2016, including 145 males and 109 females; the age range was 35-84 years and the average was 63.17 + 10.14 years. The clinical data of the system system of our hospital, including the platelet (Platelet, PLT), thrombin, and thrombin. Time (Thrombin Time, TT), activated partial thromboplastin time (Activated partial thromboplastin time, APTT), prothrombin time (Prothrombin time, PT), D- two polymer, fibrinogen and other index levels, sex, age, pathological type of lung cancer, stages (period, period). Data application 17. 0 statistical software was treated with U test. The standard was P0.05, and P0.01 had significant statistical significance. All the patients with lung cancer were followed up by telephone, outpatient and hospitalization. The follow-up period began in February 1, 2015, the time was February 31, 2017, and the shortest follow-up time was 6 months, The longest follow-up time was 24 months. During the follow-up period, other reasons were died, and the survivors were still surviving, and all were counted as the tail end. The survival curve was drawn by Logistic regression analysis and Kaplan-Meier method; the survival rate was compared with log-rank test; the multifactor survival analysis was analyzed by COX proportional risk regression model, P0.05 was The difference was statistically significant. Results 1. patients with lung cancer and control group were compared with healthy people: 316 cases in lung cancer group, 194 cases of abnormal coagulation function, 61.4% abnormal rate, 254 cases in control group, 46 cases of abnormal coagulation function and 18.1% abnormal rate (P0.01), the difference was statistically significant (P0.01).2. lung cancer group and control Compared with the control group, the difference of blood coagulation index in the lung cancer group was significantly higher than that in the control group (P0.01). The PLT count was not significant compared with the control group, and the difference was not statistically significant (P0.05).3. lung cancer patients' blood small plate, D- two polymer index level VTE distribution: the platelet count increased There were 12 cases of venous thrombosis in 85 cases of lung cancer (14.1%), 231 patients with normal platelets and 11 cases of venous thrombosis (4.8%). There were statistically significant differences (P0.01); there were 222 patients with elevated levels of D- two, including 20 (9%) with venous thrombosis and 94 patients with normal D- two polymer levels, including venous thrombosis. There were 3 cases of thrombosis (3.2%). The difference between them was statistically significant (P0.01) the pathological type of.4. lung cancer and the distribution of VTE: 316 cases of lung cancer, 127 cases of adenocarcinoma (40.2%), 101 cases of squamous cell carcinoma (32%), 88 cases of small cell lung cancer (27.8%), 13 cases of venous thrombosis (10.2%), deep vein thrombosis, pulmonary thromboembolism, pulmonary squamous cell carcinoma in the patients with lung adenocarcinoma. There were 6 cases of venous thrombosis (5.9%), 5 cases of deep venous thrombosis, 1 cases of pulmonary embolism, 4 cases of venous thrombosis (4.5%) in the patients with small cell carcinoma of the lung, all of which were deep venous thrombosis, and there was significant difference between the lung adenocarcinoma and the squamous and small cell lung cancer group (P0.05). There was no significant difference between the lung squamous cell carcinoma group and the small cell lung cancer group (P0.05).5. lung cancer. The survival time of patients with venous thrombosis and without venous thrombosis was compared: the median survival time of the lung cancer patients with VTE was 20.5 months; the median survival time of the patients with lung cancer without VTE was 23 months. The two groups were analyzed with the Log-rank survival comparison, and the time of survival in the group VTE was shorter and less than that of the VTE group. Multifactor survival analysis of patients with P0.01.6. lung cancer: multifactor survival analysis of lung cancer patients in this study. Analysis of Cox proportional risk regression analysis, statistical results of the main variables of P less than 0.05 (including age, TNM staging, PT, APTT, Fib, PLT, D- two polymer) were included in the analysis; TNM III~IV period, two polymers increased significantly, in Statistics Conclusion there is a significant adverse effect on total survival (P0.01). Conclusion 1. patients with lung cancer have a higher abnormal rate of coagulation function, and the median survival time of 2. patients with pulmonary carcinoma with venous thrombosis is shorter than that of the unmerged ones, and the elevation of 3.D- two polymer may be related to the shortening of the survival time of the patients with lung cancer.

【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

【参考文献】