中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2015年
4期
283-289
,共7页
生物学标记%血栓栓塞%肿瘤%静脉血栓栓塞%D-二聚体
生物學標記%血栓栓塞%腫瘤%靜脈血栓栓塞%D-二聚體
생물학표기%혈전전새%종류%정맥혈전전새%D-이취체
Biological markers%Thromboembolism%Neoplasms%Venous thromboembolism%D-dimer
目的：研究血栓标志物对恶性肿瘤患者静脉血栓栓塞（ VTE）风险的评估价值。方法选择2009—2012年就诊于天津医科大学总医院的恶性肿瘤患者1473例，采用ACL TOP 700型血液凝固仪测定血管性血友病因子抗原含量（ vWF：Ag）、凝血因子Ⅶ活性（ FⅦ：A）、凝血因子Ⅷ活性（ FⅧ：A）、蛋白C活性（PC：A）、蛋白S 活性（PS：A）和抗凝血酶活性（AT：A），采用法国梅里埃VIDAS荧光免疫分析仪测定血浆D-二聚体（ D-D）水平。采用受试者工作特征曲线（ROC 曲线）评价各项指标的诊断性能，对预后因素的分析采用Cox回归模型，采用Kaplan-Meier曲线进行生存分析。结果除其他未分型肿瘤外，各类型肿瘤患者中vWF：Ag、D-D和FⅦ：A水平均高于对照组（均P＜0．05）。除肾癌、前列腺癌、淋巴瘤和其他肿瘤外，各类型肿瘤患者中F Ⅷ：A水平均高于对照组（均P＜0．05）。除脑胶质瘤、乳腺癌、胃癌、肾癌和其他肿瘤外，各类型肿瘤患者中PC：A水平均低于对照组（均P＜0．05）。除脑胶质瘤、乳腺癌、前列腺癌、淋巴瘤和其他肿瘤外，各类型肿瘤患者中PS：A水平均低于对照组（均P＜0．05）。各类型肿瘤患者中AT：A水平均低于对照组（均P＜0．05）。 vWF：Ag诊断恶性肿瘤患者VTE的临界值为192％时，ROC曲线下面积为0．828（95％CI为0．716～0．939）；D-D临界值为1484 ng／ml时，ROC曲线下面积为0．915（95％CI为0．840～0．988）；PC：A临界值为75．2％时，ROC曲线下面积为0．764（95％CI为0．630～0．898）。 Cox比例风险模型显示，年龄、手术、化疗和D-D水平是恶性肿瘤患者随访3个月内发生VTE的独立风险因素。血浆D-D水平高于临界值的恶性肿瘤患者VTE累计发生概率显著增高。结论恶性肿瘤患者血浆D-D水平显著增高，并与恶性肿瘤患者的血栓风险分层和VTE风险概率密切相关，具有良好的诊断性能，可作为评价恶性肿瘤患者随访3个月内VTE风险的有效指标。
目的：研究血栓標誌物對噁性腫瘤患者靜脈血栓栓塞（ VTE）風險的評估價值。方法選擇2009—2012年就診于天津醫科大學總醫院的噁性腫瘤患者1473例，採用ACL TOP 700型血液凝固儀測定血管性血友病因子抗原含量（ vWF：Ag）、凝血因子Ⅶ活性（ FⅦ：A）、凝血因子Ⅷ活性（ FⅧ：A）、蛋白C活性（PC：A）、蛋白S 活性（PS：A）和抗凝血酶活性（AT：A），採用法國梅裏埃VIDAS熒光免疫分析儀測定血漿D-二聚體（ D-D）水平。採用受試者工作特徵麯線（ROC 麯線）評價各項指標的診斷性能，對預後因素的分析採用Cox迴歸模型，採用Kaplan-Meier麯線進行生存分析。結果除其他未分型腫瘤外，各類型腫瘤患者中vWF：Ag、D-D和FⅦ：A水平均高于對照組（均P＜0．05）。除腎癌、前列腺癌、淋巴瘤和其他腫瘤外，各類型腫瘤患者中F Ⅷ：A水平均高于對照組（均P＜0．05）。除腦膠質瘤、乳腺癌、胃癌、腎癌和其他腫瘤外，各類型腫瘤患者中PC：A水平均低于對照組（均P＜0．05）。除腦膠質瘤、乳腺癌、前列腺癌、淋巴瘤和其他腫瘤外，各類型腫瘤患者中PS：A水平均低于對照組（均P＜0．05）。各類型腫瘤患者中AT：A水平均低于對照組（均P＜0．05）。 vWF：Ag診斷噁性腫瘤患者VTE的臨界值為192％時，ROC麯線下麵積為0．828（95％CI為0．716～0．939）；D-D臨界值為1484 ng／ml時，ROC麯線下麵積為0．915（95％CI為0．840～0．988）；PC：A臨界值為75．2％時，ROC麯線下麵積為0．764（95％CI為0．630～0．898）。 Cox比例風險模型顯示，年齡、手術、化療和D-D水平是噁性腫瘤患者隨訪3箇月內髮生VTE的獨立風險因素。血漿D-D水平高于臨界值的噁性腫瘤患者VTE纍計髮生概率顯著增高。結論噁性腫瘤患者血漿D-D水平顯著增高，併與噁性腫瘤患者的血栓風險分層和VTE風險概率密切相關，具有良好的診斷性能，可作為評價噁性腫瘤患者隨訪3箇月內VTE風險的有效指標。
목적：연구혈전표지물대악성종류환자정맥혈전전새（ VTE）풍험적평고개치。방법선택2009—2012년취진우천진의과대학총의원적악성종류환자1473례，채용ACL TOP 700형혈액응고의측정혈관성혈우병인자항원함량（ vWF：Ag）、응혈인자Ⅶ활성（ FⅦ：A）、응혈인자Ⅷ활성（ FⅧ：A）、단백C활성（PC：A）、단백S 활성（PS：A）화항응혈매활성（AT：A），채용법국매리애VIDAS형광면역분석의측정혈장D-이취체（ D-D）수평。채용수시자공작특정곡선（ROC 곡선）평개각항지표적진단성능，대예후인소적분석채용Cox회귀모형，채용Kaplan-Meier곡선진행생존분석。결과제기타미분형종류외，각류형종류환자중vWF：Ag、D-D화FⅦ：A수평균고우대조조（균P＜0．05）。제신암、전렬선암、림파류화기타종류외，각류형종류환자중F Ⅷ：A수평균고우대조조（균P＜0．05）。제뇌효질류、유선암、위암、신암화기타종류외，각류형종류환자중PC：A수평균저우대조조（균P＜0．05）。제뇌효질류、유선암、전렬선암、림파류화기타종류외，각류형종류환자중PS：A수평균저우대조조（균P＜0．05）。각류형종류환자중AT：A수평균저우대조조（균P＜0．05）。 vWF：Ag진단악성종류환자VTE적림계치위192％시，ROC곡선하면적위0．828（95％CI위0．716～0．939）；D-D림계치위1484 ng／ml시，ROC곡선하면적위0．915（95％CI위0．840～0．988）；PC：A림계치위75．2％시，ROC곡선하면적위0．764（95％CI위0．630～0．898）。 Cox비례풍험모형현시，년령、수술、화료화D-D수평시악성종류환자수방3개월내발생VTE적독립풍험인소。혈장D-D수평고우림계치적악성종류환자VTE루계발생개솔현저증고。결론악성종류환자혈장D-D수평현저증고，병여악성종류환자적혈전풍험분층화VTE풍험개솔밀절상관，구유량호적진단성능，가작위평개악성종류환자수방3개월내VTE풍험적유효지표。
Objective To assess the value of thrombotic biomarkers in estimation of venous thromboembolism ( VTE) risk in cancer patients.Methods A total of 1473 cancer patients treated in the Tianjin Medical University General Hospital from 2009 to 201 were selected, including 845 males and 628 females in the age of 56±17 years.The activities of von Willebrand factor antigen ( vWF:Ag) , factorⅦ( FⅦ:A), factor Ⅷ (FⅧ:A), antithrombin (AT:A), protein C (PC:A) and protein S (PS:A) were assayed using an ACL TOP 700 blood coagulation analyzer.The level of D-dimer ( D-D) was assayed using the Biomerieux Mini Vidas Automated Immunoassay Analyzer.Receiver operating characteristic curve ( ROC) was used to analyze the diagnostic performance of the parameters.Cox regression analysis model was applied to evaluate the effect on prognosis, and Kaplan-Meier curve was used to implement the survival analysis.Results The levels of vWF:Ag, D-D, and FⅧ:A were significantly higher in all the specified tumor groups ( except the other tumor group ) than that of the control groups ( P<0.05 ) .FⅧ:A was significantly higher than that in the control group in all tumor groups except the renal carcinoma, prostatic cancer, lymphoma groups and the other tumor group ( P<0.05) .The PC:A level was significantly lower in all tumor patients groups than in the control group, except glioma, breast cancer, gastric carcinoma, renal carcinoma and the other tumors groups ( P<0.05) .The PS:A level was significantly lower in all tumor groups than in the control group, except the glioma, breast cancer, prostatic cancer, lymphoma and the other tumors groups (P<0.05).The AT:A level was significantly lower in all tumor groups than in the control group (P<0.05).When the optimum cut-off point of vWF:Ag for VTE diagnosis was 192%in the cancer group, the area under ROC curve=0.828 ( 95%CI:0.716 to 0.939) .When the optimum cut-off point of D-dimer for VTE diagnosis was 1484 ng/ml in the cancer group, the area under ROC curve=0.915 ( 95%confidence interval: 0.840 to 0.988).When the optimum cut-off point of PC:A for VTE diagnosis was 75.2%in the cancer group, the area under ROC curve=0.764 ( 95%confidence interval:0.630 to 0.898) . The Cox analysis showed that age, surgery, chemotherapy and D-dimer were independent risk factors for VTE event within three months in cancer patients.The cumulative probability of VTE was increased significantly in the cancer patients if whose plasma D-dimer level was over the cut-off value.Conclusions The plasma D-dimer level is obviously increased in cancer patients, and there is a relevance to thrombosis risk stratification and VTE cumulative probability.It is with good diagnostic performance, and may be used as an effective marker in estimation of VTE risk within 3 months in cancer patients.
