本文選題：胃癌　切入點(diǎn)：肝轉(zhuǎn)移　出處：《河北醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:我國胃癌發(fā)病率高,分別居男性第2位、女性第3位,且易于早期發(fā)生肝轉(zhuǎn)移,預(yù)后差。前期研究表明,胃癌根治術(shù)前存在高纖維蛋白原血癥可預(yù)測疾病分期晚、腫瘤浸潤程度深、淋巴結(jié)轉(zhuǎn)移及病變范圍廣,并影響患者總生存。國內(nèi)目前尚缺乏血漿纖維蛋白原水平與胃癌肝轉(zhuǎn)移的相關(guān)研究。本文主要探究初診即存在肝轉(zhuǎn)移的胃癌患者血漿纖維蛋白原水平與臨床病理參數(shù)的關(guān)系,及治療前后血漿纖維蛋白原水平的變化與預(yù)測療效的價(jià)值并預(yù)測預(yù)后,為臨床治療提供參考。方法:搜集2010年1月至2014年12月間于河北醫(yī)科大學(xué)第四醫(yī)院普通外科就診的胃惡性腫瘤患者的住院病歷資料及隨訪數(shù)據(jù)�；颊呓y(tǒng)一于治療前1周內(nèi)行血常規(guī)、肝腎功能、凝血功能及胃癌腫瘤標(biāo)志物檢測,并由我院檢驗(yàn)科統(tǒng)一出具相關(guān)實(shí)驗(yàn)室檢查結(jié)果。應(yīng)用SPSS13.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)分析,探究纖維蛋白原與胃癌肝轉(zhuǎn)移臨床病理參數(shù)的關(guān)系和預(yù)測療效及預(yù)后的價(jià)值。結(jié)果:1共437例胃癌患者符合入組條件進(jìn)入本研究,其中分期早、接受胃癌根治術(shù)者248例,初診即合并肝轉(zhuǎn)移且無手術(shù)機(jī)會(huì)者189例。早期胃癌患者其血漿平均纖維蛋白原水平為3.28±1.06g/L;肝轉(zhuǎn)移患者血漿纖維蛋白原平均水平為3.70±1.02g/L,T檢驗(yàn)得出初診即存在肝轉(zhuǎn)移的Ⅳ期患者其血漿纖維蛋白原水平顯著高于可行根治性術(shù)的早期患者。進(jìn)一步統(tǒng)計(jì)學(xué)分析表明,肝轉(zhuǎn)移患者中高纖維蛋白原血癥的發(fā)生率明顯高于早期患者(20.63%vs.8.87%;P0.001)。2進(jìn)一步統(tǒng)計(jì)學(xué)分析顯示,當(dāng)發(fā)生胃癌肝轉(zhuǎn)移時(shí),在全身感染性指標(biāo)—PLT(P=0.001)、白蛋白水平(P=0.010)及PLR評(píng)分(P=0.018)水平升高的患者中血漿纖維蛋白原水平較高。且在老年患者中,血漿纖維蛋白原水平亦有升高趨勢,但與性別及腫瘤在胃內(nèi)生長部位等方面無關(guān)(P0.05)。此外,雖然肝臟內(nèi)轉(zhuǎn)移病灶個(gè)數(shù)及肝功能情況對(duì)血漿纖維蛋白原水平均有一定影響,但兩者均無統(tǒng)計(jì)學(xué)意義(P0.05)。而在除肝臟以外合并其他臟器轉(zhuǎn)移、存在腹腔或遠(yuǎn)處淋巴結(jié)轉(zhuǎn)移的患者中,其血漿纖維蛋白原水平明顯升高(P0.05),對(duì)疾病分期晚有進(jìn)一步提示意義。但與胃癌腫瘤標(biāo)志物—CEA(P=0.710)、CA19-9(P=0.450)、CA72-4(P=0.40)、CA50(P=0.631)水平均無關(guān)。3在189例胃癌肝轉(zhuǎn)移患者中共51例患者收集到療效數(shù)據(jù),其中治療緩解者(PR者)17例,未緩解者(SD+PD者)34例,無CR患者。在治療緩解者中,治療后血漿纖維蛋白原水平下降明顯,存在統(tǒng)計(jì)學(xué)差異(P=0.011);而在未緩解者中,治療前后血漿纖維蛋白原水平差異不顯著(P=0.476),但血漿纖維蛋白原水平有升高趨勢。4在初診即存在肝轉(zhuǎn)移的胃癌患者中,治療前即存在高纖維蛋白原血癥的39例患者中死亡30例,死亡率為76.92%,在150例血漿纖維蛋白原水平正常的患者中死亡119例,死亡率為79.33%,統(tǒng)計(jì)學(xué)示二者無顯著差別(P0.05)。進(jìn)一步生存分析顯示,二者生存率無顯著統(tǒng)計(jì)學(xué)差異(Log-Rank test;P=0.829),但存在高纖維蛋白原血癥的患者其總生存期(OS)有下降趨勢,提示臨床預(yù)后差。結(jié)論:本研究提示,胃癌肝轉(zhuǎn)移患者其血漿纖維蛋白原水平較可行根治術(shù)的早期患者顯著升高,且與全身感染性指標(biāo)等多種臨床病理因素密切相關(guān),可作為一個(gè)敏感的血液學(xué)指標(biāo)提示患者治療效果及預(yù)測患者不良預(yù)后,對(duì)臨床工作來說經(jīng)濟(jì)、簡單實(shí)用,可為患者帶來較大裨益。
[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.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R735.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 喬呈瑞;趙松;李向楠;趙佳;朱登彥;吳愷;曹克鑫;;外周血纖維蛋白原及血小板與食管鱗癌臨床病理特征及其預(yù)后的相關(guān)性[J];中國老年學(xué)雜志;2016年02期

2 許罡;汪棟;周源;劉宏;;纖維蛋白原、血小板計(jì)數(shù)水平在非小細(xì)胞肺癌中的臨床意義[J];中外醫(yī)療;2015年34期

3 李晨;杜曉輝;徐迎新;陳凜;夏紹友;張勇;;胃癌患者術(shù)前中性粒細(xì)胞淋巴細(xì)胞比率與淋巴結(jié)轉(zhuǎn)移相關(guān)性臨床研究[J];醫(yī)學(xué)研究雜志;2015年01期

4 黃永紅;曹云飛;高楓;張森;黃家豪;龍軍先;;Th22細(xì)胞及相關(guān)因子在結(jié)直腸癌的表達(dá)[J];免疫學(xué)雜志;2014年09期

5 張亞萍;魏嘉;楊陽;沈潔;劉寶瑞;;影響進(jìn)展期胃癌預(yù)后的多因素分析[J];臨床腫瘤學(xué)雜志;2014年06期

6 喬志偉;張靜;王純雁;;外周血血小板計(jì)數(shù)及纖維蛋白原含量在上皮性卵巢癌診治中的意義[J];腫瘤學(xué)雜志;2014年03期

7 Marco Candela;Silvia Turroni;Elena Biagi;Franck Carbonero;Simone Rampelli;Carla Fiorentini;Patrizia Brigidi;;Inflammation and colorectal cancer, when microbiota-host mutualism breaks[J];World Journal of Gastroenterology;2014年04期

8 張偉德;嚴(yán)芝強(qiáng);;血漿纖維蛋白原在胃癌診斷及轉(zhuǎn)移中的臨床價(jià)值[J];貴陽醫(yī)學(xué)院學(xué)報(bào);2012年06期

9 戴慶忠;覃瑜;;惡性腫瘤患者凝血指標(biāo)檢測的臨床意義[J];檢驗(yàn)醫(yī)學(xué)與臨床;2009年05期

10 林懿,林英城,林文照,王鴻彪,林穗玲,曾德,霍霞;纖維蛋白原水平在惡性腫瘤診治中的臨床意義[J];中國癌癥雜志;2004年06期

相關(guān)碩士學(xué)位論文 前1條

1 蘇毓;高纖維蛋白原血癥同胃癌術(shù)前臨床病理參數(shù)的關(guān)系及預(yù)后分析[D];河北醫(yī)科大學(xué);2015年

，

本文編號(hào)：1586212