摘要
目的 :探讨晚期肺癌患者凝血异常机理和抗凝治疗对预后的影响。方法 :采用酶联免疫方法检测 2 8例晚期肺癌患者和 2 0例健康体检者与凝血 ,纤溶、内皮细胞的激活及内源性抗凝防御活性相关的一些实验室指标 ,包括血浆D -二聚体 (D -dimer) ,血浆蛋白C(PC) ,血浆蛋白S(PS) ,血浆调节蛋白 (TM ) ,血浆抗凝血酶Ⅲ活性 (AT -Ⅲ ) ,血浆纤溶酶原激活物 (tPA) ,I型纤溶酶原激活物抑制物 (PAI -Ⅰ ) ,血清同型半胱氨酸 (tHCY) ,抗心磷脂抗体 (aPA ,包括IgA ,IgM ,IgG)。并对 7例无活动性出血或潜在严重出血倾向患者在接受化疗期间同时给予预防性的抗凝治疗 (低分子肝素钙速避凝 ,0 .1mL/ 10kg每日 2次皮下注射 ) ;另对 8例患者仅接受化疗治疗 ,随访 6个月观察抗凝对预后的影响。结果 :肺癌患者D -dimer ,TM ,PAI-Ⅰ ,tHCY ,aPA的IgG ,IgA较对照组显著升高 (P <0 .0 5) ,PS ,AT -Ⅲ较对照组显著降低 (P <0 .0 5) ,但PC ,tPA ,aPA的IgM两组间无显著差异 (P >0 .0 5)。随访观察 ,抗凝 +化疗患者 ,1例患者因便血和 1例患者因咯血而终止抗凝治疗 ,1例患者发生深静脉血栓形成 (DVT) ,其中位生存时间为 18周 ;仅化疗患者 ,3例患者发生DVT和肺血栓栓塞症 (PTE) ,2例患者高度疑诊PTE(家属拒绝进一步检查未能确诊 ) ,其中?
Objective:To explore the mechanism of coagulable abnormality and the effect of anticoagulation on prognosis in advanced cases of lung cancer. M ethods:The level of plasma D-dimer, TM, tPA,PAI-Ⅰ,PC,PS, AT-Ⅲ, aPA(IgA ,IgM,IgG) ,and serum tHCY, were measured by ELISA technique in 28 advanced cases of lung c ancer and 20 control subjects. Then 7 patients without blooding and without poss ible severe blooding were treated by anticoagulation( Nadroparin 0.1 mL/10kg,b.i . d, i.h ) during chemotherapy; other 8 patients were only treated by chemotherapy . Finally, the response and survival time were followed up in six months. Results:the levels of D-dimer,TM, PAI-Ⅰ,tHCY,aPA (IgG ,IgA) in lung cancer group were significantly ele vated P<0.05, while the levels of PS , AT-Ⅲ were greatly decreased ,compa red with th e control group ,no significant difference in levels of PC, tPA, and aPA (IgM)( P>0.05). The follow-up results: there were 2 cases complicated with deep venous thrombosi s (DVT) and median survival time was 18 weeks in anticoagulation group ,whil e 3 cases with DVT and pulmonary thromboembolism (PTE)and median survival tim e was 12 weeks in non-anticoagulation group. Conclusions:The hyper coagulable state in advanced cases of lung cancer is related to the activizing of coagulable system , fibrinolytic system, and endotheliocyte as well as d ecrease of endo- anticoagulable activity. Anticoagulation may reduce the occu rrence of DVT and PTE and to prolong survival time, but it is needed to furth er investigate its effectiveness and safety because the cases is too few。
出处
《医学理论与实践》
2003年第11期1243-1245,共3页
The Journal of Medical Theory and Practice
