CAJ | 학술논문

目的：探讨晚期非小细胞肺癌（NSCLC）患者化疗前后凝血指标的改变及其临床意义。方法选取48例晚期 NSCLC患者（肺癌组，按治疗效果再将完全缓解＋部分缓解的患者归为有效组；稳定＋进展归为无效组），选取同期健康体检者作为对照组（n＝25）。测量对照组及肺癌组化疗前后的血浆凝血酶原时间（PT）、部分凝血活酶时间（APTT）、纤维蛋白原（Fib）、D-二聚体（D-D）、血小板（PLT）及抗凝血酶Ⅲ（AT-Ⅲ）等指标。结果肺癌组化疗前与对照组比较 Fib、D-D、PLT显著升高（P＜0．05），AT-Ⅲ显著降低（P＜0．05），2组 PT及 APTT比较差异无统计学意义（P＞0．05）。有效组与无效组化疗前各项指标差异无统计学意义（P＞0．05）；有效组化疗后较化疗前Fib、D-D、PLT显著降低（P＜0．05），AT-Ⅲ显著升高（P＜0．05），PT及 APTT差异无统计学意义（P＞0．05）；无效组化疗前后各项指标差异无统计学意义（P＞0．05）。结论凝血指标的显著变化对晚期 NSCLC的诊断有一定价值；晚期 NSCLC存在凝血功能异常，有效的化疗可改善患者的凝血功能状态，凝血指标的显著变化可作为患者化疗效果及预后评判的参考依据。
목적：탐토만기비소세포폐암（NSCLC）환자화료전후응혈지표적개변급기림상의의。방법선취48례만기 NSCLC환자（폐암조，안치료효과재장완전완해＋부분완해적환자귀위유효조；은정＋진전귀위무효조），선취동기건강체검자작위대조조（n＝25）。측량대조조급폐암조화료전후적혈장응혈매원시간（PT）、부분응혈활매시간（APTT）、섬유단백원（Fib）、D-이취체（D-D）、혈소판（PLT）급항응혈매Ⅲ（AT-Ⅲ）등지표。결과폐암조화료전여대조조비교 Fib、D-D、PLT현저승고（P＜0．05），AT-Ⅲ현저강저（P＜0．05），2조 PT급 APTT비교차이무통계학의의（P＞0．05）。유효조여무효조화료전각항지표차이무통계학의의（P＞0．05）；유효조화료후교화료전Fib、D-D、PLT현저강저（P＜0．05），AT-Ⅲ현저승고（P＜0．05），PT급 APTT차이무통계학의의（P＞0．05）；무효조화료전후각항지표차이무통계학의의（P＞0．05）。결론응혈지표적현저변화대만기 NSCLC적진단유일정개치；만기 NSCLC존재응혈공능이상，유효적화료가개선환자적응혈공능상태，응혈지표적현저변화가작위환자화료효과급예후평판적삼고의거。
Objective To investigate the changes in coagulation indexes before and after chem-otherapy and their clinical significance in patients with advanced non-small cell lung cancer (NSCLC).Methods Prothrombin time(PT),activated partial thromboplastin time(APTT),fi-brinogen(Fib),D-dimer(D-D),platelet(PLT),antithrombin Ⅲ(AT-Ⅲ)and other coagulation in-dexes were measured before and after chemotherapy in 48 patients with advanced NSCLC(NSCLC group)and 25 healthy subjects(control group).In addition,patients with advanced NSCLC were further divided into two groups:effective group(complete remission+partial remission)and inef-fective group(stable disease+progressive disease).Results Compared with control group,levels of Fib,D-D and PLT increased and levels of AT-Ⅲ decreased in NSCLC group before chemothera-py(P<0.05).No significant differences in PT and APTT were found between the two groups be-fore chemotherapy(P>0.05).Moreover,there were no significant differences in all indexes be-tween effective group and ineffective group before chemotherapy(P>0.05).In effective group, levels of Fib,D-D and PLT decreased and levels of AT-Ⅲ increased after chemotherapy (P<0.05),but no obvious changes were found in PT and APTT after chemotherapy(P>0.05).In in-effective group,all indexes were not changed after chemotherapy(P>0.05).Conclusion Changes in coagulation indexes are valuable for the diagnosis of advanced NSCLC.Patients with advanced NSCLC have abnormal coagulation function,which can be improved by effective chemotherapy. Therefore,changes in coagulation indexes can be used as the reference for the evaluation of chem-otherapy efficacy and prognosis in patients with advanced NSCLC.