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Title: [The changes of blood coagulation in surgical patients with lung cancer].
Author: Xu C, Fu X.
Journal: Zhongguo Fei Ai Za Zhi; 2010 Feb; 13(2):136-9. PubMed ID: 20673507.
Abstract:
BACKGROUND AND OBJECTIVE: Patients with malignant tumor are at high risk of thrombophilia, which contributes to thromboembolism. Surgical treatment is one of the critical risk factors. In this study, changes and clinical significances of blood coagulation of lung cancer patients pre- and post operation were investigated. METHODS: A prospective, controlled study were carried out in 74 lung disease patients, who were divided into lung cancer group and benign lung disease group. In each group, pre- and postoperative changes in prothrombin time (PT), activated partial thromboplastin time (APT), platelet count (PLT), D-dimer (D-D) and fibrinogen (Fib) and clinical performances were observed and compared in intra- and intergroups. RESULTS: The concentration of Fib both in lung cancer group and its subgroup (adenocarcinoma of lung) increased, preoperative differences between benign lung disease group and subgroup (squamous cell carcinoma of lung) was significant (P < 0.05). PT (postoperative 1st to 7th day) in lung cancer group prolonged, APTT (postoperative 3rd to 7th day) reduced, Fib (postoperative 3rd to 7th day) and D-D (postoperative 1st to 7th day) increased, PLT reduced on the 1st, 3rd day but then increased on the 5th, 7th day after operation, the difference between pre- and post-operation was significant (P < 0.05). D-D and PT in lung cancer group on the 7th day was longer than in benign lung disease group (P < 0.05). One pulmonary thromboembolism (PTE) case in lung cancer group occurred, while in benign lung disease group none venous thromboembolism (VTE) appeared. CONCLUSION: Patients with lung cancer are in high hypercoagulable state, and prone to VTE. It is necessary to take some interventions to avoid VTE. 背景与目的: 恶性肿瘤可引起机体高凝血状态, 可能导致血栓栓塞症的发生, 手术创伤则是重要的危险因素。本研究探讨肺癌患者手术前后凝血状态、变化及临床意义。方法: 采用前瞻性对照研究方法, 选取普胸外科临床有效病例74例, 分为肺癌组和肺良性疾病组。观察患者术前和术后凝血酶原时间(prothrombin time, PT)、活化的部分凝血活酶时间(activated partial thromboplastin time, APTT)、血小板计数(platelet count, PLT)、D二聚体(D-dimer, D-D)及纤维蛋白原(fibrinogen, Fib)等指标反应的凝血功能状态、变化及临床表现, 比较组间组内之间的差别。结果: 术前肺癌组较肺良性疾病组患者以及肺癌类型中腺癌患者较鳞癌患者术前Fib升高并高于正常值(P < 0.05)。肺癌组患者出现PT在术后第1天-第7天延长, APTT在术后第3天-第7天缩短, Fib在术后第3天-第7天、D-D在术后第1天-第7天升高, PLT在术后第1天、第3天较术前呈下降趋势而术后第5天、第7天有升高趋势, 与术前比较差异有统计学意义(P < 0.05)。肺癌组较肺良性疾病组患者术后第7天PT、D-D升高(P < 0.05)。术后肺癌组出现1例肺血栓栓塞症(pulmonary thromboembolism, PTE), 肺良性疾病组未出现静脉血栓栓塞症(venous thromboembolism, VTE)。结论: 肺癌患者手术前后易出现高血凝状态并发VTE, 有必要行一定的干预措施避免VTE的发生。

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