摘要
目的动态观察消化系统恶性肿瘤患者在有无肿瘤复发转移不同时期的止凝血功能的变化,以探索其止凝血机制的常规检测指标及分子标志物的改变在消化系统恶性肿瘤患者中的诊断、预后判断中的意义。方法对30例正常对照组人群和42例消化系统恶性肿瘤患者进行常规止凝血功能的检测,包括PLT、PT、aPTT、TT、Fbg及血小板活化、凝血、抗凝血和纤溶指标的分子标志物的检测,包括GMP-140、TF、TAT、TFPI、TpP、PAP、u-PA、t-PA、PAI-1、D-D含量和凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅸ、Ⅹ和Ⅺ活性及抗凝血酶AT活性。结果①消化系统恶性肿瘤患者中均有Fbg升高(P<0.05),在疾病复发转移组中升高更加明显(P<0.01),同时在复发转移组中又出现了PT、aPTT的缩短(P<0.05)。②消化系统恶性肿瘤组中均存在着GMP-140、TF、TAT和TpP的升高(P<0.05)、且在肿瘤复发转移组中升高得更明显(P<0.05或P<0.01),同时在这组患者中又有凝血因子Ⅶ、X活性的升高和AT活性的降低(P<0.05)。③在消化系统恶性肿瘤组中存在着纤溶指标PAP、u-PA、t-PA和D-D含量的升高(P<0.05),在肿瘤复发转移组中这些指标升高得更明显(P<0.05或P<0.01),而在这组患者中又出现了纤溶酶原抑制物PAI-1含量的升高(P<0.05)。结论消化系统恶性肿瘤患者体内同时存在着血小板活化、凝血激活、抗凝血抑制和纤溶系统的活化。在消化系统恶性肿瘤患者中,常规止凝血功能的指标除Fbg含量变化与肿瘤复发转移明显相关外,其余指标变化不大,而血小板活化、凝血、抗凝血和纤溶系统的分子标志物水平的改变,对消化系统恶性肿瘤患者复发转移的止凝血功能异常的意义更明显,可作为消化系统恶性肿瘤的预测、肿瘤复发转移以及判断预后的敏感指标。
Objective To investigate the haemostatic changes of patients with gastrointestinal cancer at the different stages,such as disease in relapse or metastasis.Methods Routine haemostatic tests were conducted among 42 patients with gastrointestinal cancer.30 healthy volunteers were enrolled as controls.The tests included the plasma concentration of PLT,PT,aPTT,TT,Fbg.Some coagulable and fibrinolytic molecular markers,such as GMP-140,TF,TAT,TFPI,TpP,PAP,u-PA,t-PA,PAI-1 were also measured.The activities of coagulation factors Ⅱ,Ⅴ,Ⅶ,Ⅷ,Ⅸ,Ⅹ,Ⅺ and AT were evaluated as well.Results ① The plasma of Fbg were elevated in gastrointestinal cancer patients（P〈0.05）,while in relapse and metastasis groups,the levels were significantly higher than that of the control（P〈0.01）.At the same time,PT and aPTT were shortened（P〈0.05）.② The plasma levels of GMP-140,TF,TAT and TpP were elevated in gastrointestinal cancer patients（P〈0.05）.In the meanwhile,the levels significantly higher than that of the control（P〈0.05 or P〈0.01） in the relapse and metastasis groups,Increased activity of coagulation factors Ⅶ,X and decreased activity of AT also took place at the same time（P〈0.05）.③ Compared with the normal control,the patients with gastrointestinal cancer had higher concentrations of fibrinolytic parameters,such as PAP,u-PA,t-PA and D-dimer（P〈0.05）.While in the relapse and metastasis,all these parameters raised more remarkably（P〈0.05 or P〈0.01）.Furthermore,the concentration of fibrinogen inhibitor PAI-1 was also elevated（P〈0.05）.Conclusion Patients with gastrointestinal cancer may harbor platelet aggregation,activation of coagulation cascade,decreased synthesis of anticoagulant proteins and abnormal activation of fibrinolysis.In the group of the patients with gastrointestinal cancer,the plasma levels of Fbg plays an important role in predicting the relapse and metastasis of the disease.Other changes of routine results seems to have no definite impact on the progress of disease.Variable levels of the molecular markers of platelet activation、coagulable and fibrinolitic system changed remarkably in patients with relapse and metastasis.Therefore,these markers could be considered as sensitive predicators of progress.
出处
《血栓与止血学》
2011年第5期214-218,共5页
Chinese Journal of Thrombosis and Hemostasis
关键词
消化系统恶性肿瘤
复发转移
止凝血功能
分子标志物
Gastrointestinal cancer
Relapse and metastasis
Haemostatic function
Molecular marker
