發(fā)布時間：2018-08-18 15:55

【摘要】：目的1、評估術(shù)前常規(guī)凝血檢測水平與非小細(xì)胞肺癌(NSCLC)患者行根治性完整切除術(shù)后總生存率的相關(guān)性。2、術(shù)前中性粒細(xì)胞淋巴細(xì)胞比率(NLR)對于行根治性切除的非小細(xì)胞肺癌(NSCLC)患者的臨床意義方法選取2004年1月至2008年12月在天津醫(yī)科大學(xué)腫瘤醫(yī)院行完全性切除手術(shù)的NSCLC患者754例納入凝血檢測以及同期患者681例行根治性切除的非小細(xì)胞肺癌患者納入NLR研究,利用Kruskall-Wallis和Mann-Whitney U檢驗(yàn),評價術(shù)前常規(guī)凝血檢測水平、術(shù)前中性粒細(xì)胞淋巴細(xì)胞比率與其他變量的相關(guān)性,并且通過單變量和多變量分析確定凝血功能以及中性粒細(xì)胞淋巴細(xì)胞比率的術(shù)前水平和總體生存率之間的關(guān)聯(lián)。結(jié)果1、所有術(shù)前常規(guī)凝血檢測水平(血漿凝血酶原時間(PT);國際標(biāo)準(zhǔn)化比值(INR);活化部分凝血活酶時間(APTT);凝血酶時間(TT);纖維蛋白原(Fbg);D-二聚體)與NSCLC患者T分期及臨床分期均存在相關(guān)性。單因素分析顯示,術(shù)前凝血試驗(yàn)中PT(χ~2=8.254,P=0.004)和INR(χ~2=5.404,P=0.020)延長,以及異常升高的Fbg(χ~2=9.184,P=0.002)和D-二聚體(χ~2=9.184,P=0.002)水平提示預(yù)后較差。多變量模型證實(shí)術(shù)前D-二聚體為NSCLC患者預(yù)后的獨(dú)立因素(P=0.019)。2、根據(jù)ROC曲線,選取2.3作為中性粒細(xì)胞淋巴細(xì)胞比率的界值。其中269名患者NLR2.3,412名患者NLR≤2.3。NLR2.3患者總體生存期(OS)是明顯低于NLR≤2.3患者(34.1%VS 56.1%,P0.001)。單因素分析顯示,手術(shù)方式(P=0.044),腫瘤病變部位(P=0.034),病理分期(P0.001),化療與否(P=0.007),單核細(xì)胞(P=0.003),乳酸脫氫酶(LDH)(P0.001),纖維蛋白原(Fbg)(P=0.001),和D-二聚體(P=0.012)與5年OS率顯著相關(guān)。多變量分析顯示術(shù)前NLR是影響NSCLC患者的獨(dú)立危險(xiǎn)因素(P0.001;危險(xiǎn)比:1.640;95%置信區(qū)間:1.319-2.038)。結(jié)論1、術(shù)前凝血檢測中PT和INR延長以及Fbg和D-二聚體水平升高提示NSCLC患者預(yù)后不良,而術(shù)前凝血檢測中D-二聚體是行根治性手術(shù)NSCLC患者的獨(dú)立預(yù)后因素。2、術(shù)前NLR可作為預(yù)測行根治性切除的非小細(xì)胞肺癌患者預(yù)后的因子。
[Abstract]:Objective 1. To evaluate the correlation between preoperative routine coagulation and overall survival rate after radical complete resection in patients with non-small cell lung cancer (NSCLC). The ratio of neutrophils to lymphocytes (NLR) in patients with NSCLC after radical resection was evaluated. Clinical significance of (NSCLC) patients with lung cancer 754 patients with NSCLC underwent complete resection from January 2004 to December 2008 in Tianjin Medical University Oncology Hospital and 681 patients underwent radical resection in the same period Patients with non-small cell lung cancer were included in the NLR study. Kruskall-Wallis and Mann-Whitney U tests were used to evaluate the correlation between preoperative neutrophil lymphocyte ratio and other variables. Univariate and multivariate analysis was used to determine the relationship between preoperative level of coagulation and neutrophil lymphocyte ratio and overall survival rate. Results 1. All preoperative routine coagulation levels (plasma prothrombin time (PT); international standardized ratio (INR); activated partial thromboplastin time (APTT); thrombin time (TT); fibrinogen (Fbg) (Fbg) D-dimer) and T stage and clinical features of NSCLC patients There was correlation between stages. Univariate analysis showed that the prolongation of PT and INR in preoperative coagulation test (蠂 ~ (2) 2) and INR (蠂 ~ (2 +) 5.404), as well as the abnormal elevation of Fbg (蠂 ~ (29.184) P ~ (0.002) and D-dimer (蠂 ~ (29) ~ (184) P ~ (0.002) suggested a poor prognosis. The multivariate model confirmed that preoperative D- dimer was an independent prognostic factor in patients with NSCLC (P0. 019). According to the ROC curve, 2. 3 was selected as the limit value of neutrophil lymphocyte ratio. The overall survival time (OS) of 269 NLR2.3412 patients with NLR 鈮，

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