本文選題：惡性腫瘤 + 凝血指標(biāo)��； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景惡性腫瘤的發(fā)病率與死亡率逐年上升,尤其是肺癌,其發(fā)病率位于世界第一位。大量研究證實,惡性腫瘤遠(yuǎn)處轉(zhuǎn)移和血栓形成是其死亡的兩大主要原因。2015年美國臨床腫瘤學(xué)會(American Society of Clinical Oncology,ASCO)臨床指南建議,肺癌、胃癌等患者在住院治療期間均應(yīng)該監(jiān)測凝血功能變化,定期評估血栓形成的風(fēng)險,對于高�；颊呖深A(yù)防性抗凝治療,可延長患者的生存期、提高生活質(zhì)量。目前多數(shù)臨床醫(yī)生對惡性腫瘤合并血栓的現(xiàn)象尚未引起足夠的重視,影響了患者的生存質(zhì)量,縮短了患者的生存時間。目的探討肺癌患者凝血指標(biāo)的變化,發(fā)現(xiàn)肺癌患者發(fā)生血栓的相關(guān)因素,分析血栓形成與肺癌患者預(yù)后的關(guān)系。方法回顧性分析2015年1月1日至2016年12月31日就診于解放軍第一五二中心醫(yī)院的316例肺癌患者和254例健康體檢者的凝血指標(biāo)。樣本的總體情況:2015年1月至2016年12月就診于解放軍第一五二中心醫(yī)院的316例肺癌患者,其中男性205例,女性111例;年齡在35-85歲之間,平均65.49±12.01;肺癌組按血小板計數(shù)是否升高分為:血小板升高組85例(26.9%),血小板計數(shù)正常組231例(73.1%);按D-二聚體是否升高分為:D-二聚體升高組222例(70.3%),D-二聚體正常組94例(29.7%);按病理類型進(jìn)行分組:腺癌127例(40.2%),鱗癌101例(32.0%),小細(xì)胞肺癌88例(27.8%);按腫瘤臨床分期分為I~II期組與III~IV期組,I~II期組85人(26.9%),III~IV期組231人(73.1%);對照組為2015年1月至2016年12月在我院體檢的健康人群254人,其中男性145例,女性109例;年齡范圍在35-84歲,平均63.17±10.14歲。通過我院病例系統(tǒng)統(tǒng)計對象的臨床資料,包括血小板(Platelet,PLT)、凝血酶時間(Thrombin Time,TT)、活化部分凝血活酶時間(Activated partial thromboplastin time,APTT)、凝血酶原時間(Prothrombin time,PT)、D-二聚體(D-dimer,D-D)、纖維蛋白原(Fibrinogen,FIB)等指標(biāo)水平以及性別、年齡、肺癌的病理類型、分期(I~II期、III~IV期)。數(shù)據(jù)應(yīng)用SPSS 17.0統(tǒng)計軟件進(jìn)行處理,組間對比采用u檢驗,標(biāo)準(zhǔn)為P0.05有統(tǒng)計學(xué)意義,P0.01有顯著統(tǒng)計學(xué)意義。對本研究中所有肺癌患者進(jìn)行隨訪,隨訪方式主要為電話、門診及住院等。隨訪從2015年2月1日開始,截止時間為2017年2月31日,最短隨訪時間6個月,最長隨訪時間24個月。隨訪期間死于其他原因、失訪或研究截止時仍生存者,均計為截尾值。采用Logistic回歸多因素分析,用Kaplan-Meier法繪制生存曲線;生存率比較采用log-rank檢驗;多因素生存分析采用COX比例風(fēng)險回歸模型進(jìn)行分析,P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果1.肺癌組與對照組健康人群凝血功能異常率的比較:肺癌組患者共316例,凝血功能異常者194例,異常率61.4%;對照組254例,凝血功能異常者46例,異常率18.1%,兩者相比,其差別有顯著統(tǒng)計學(xué)意義(P0.01)。2.肺癌組與對照組各凝血指標(biāo)的比較:肺癌組患者各凝血指標(biāo)陽性率均明顯升高,與對照組相比,差別有顯著統(tǒng)計學(xué)意義(P0.01);PLT計數(shù)與對照組相比變化不明顯,差別無統(tǒng)計學(xué)意義(P0.05)。3.肺癌患者血小板、D-二聚體指標(biāo)水平的VTE分布:血小板計數(shù)升高的85例肺癌患者并發(fā)靜脈血栓12例(14.1%),血小板計數(shù)正常的231例肺癌患者并發(fā)靜脈血栓11例(4.8%),兩者之間具有統(tǒng)計學(xué)差異(P0.01);D-二聚體水平升高者共222例病人,其中并發(fā)靜脈血栓20例(9.0%),D-二聚體水平正常者共94例病人,其中并發(fā)靜脈血栓3例(3.2%),兩者之間差異具有統(tǒng)計學(xué)意義(P0.01)。4.肺癌患者病理類型與VTE的分布:316例肺癌患者,其中腺癌127例(40.2%),鱗癌101例(32.0%),小細(xì)胞肺癌88例(27.8%)。肺腺癌患者中并發(fā)靜脈血栓13例(10.2%),深靜脈血栓12例,肺栓塞1例;肺鱗癌患者中并發(fā)靜脈血栓6例(5.9%),深靜脈血栓5例,肺栓塞1例;肺小細(xì)胞癌患者中并發(fā)靜脈血栓4例(4.5%),均為深靜脈血栓;肺腺癌與鱗癌及小細(xì)胞肺癌組差異有統(tǒng)計學(xué)意義(P0.05),肺鱗癌患者組與小細(xì)胞肺癌患者組差異無統(tǒng)計學(xué)意義(P0.05)。5.肺癌合并靜脈血栓的患者與未合并靜脈血栓的患者生存時間的比較:肺癌合并VTE患者中位生存時間為20.5月;肺癌未合并VTE患者中位生存時間為23月。采用Log-rank生存比較對這兩組患者進(jìn)行分析,VTE組生存時間較未合并VTE組短且有統(tǒng)計學(xué)差異(P0.01)。6.肺癌患者多因素生存分析:本研究對肺癌患者進(jìn)行多因素生存分析。分析采用Cox比例風(fēng)險回歸分析,統(tǒng)計結(jié)果P值小于0.05的主要變量(包括年齡、TNM分期、PT、APTT、Fib、PLT、D-二聚體)被納入了分析;TNM III~IV期、D-二聚體顯著升高,在統(tǒng)計分析上對總生存有顯著的不利影響(P0.01)。結(jié)論1.肺癌患者凝血功能異常率較高;2.肺癌合并靜脈血栓者的中位生存時間較未合并者短;3.D-二聚體升高與肺癌患者生存時間縮短可能有關(guān)。
[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.

【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2

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