恶性肿瘤患者凝血 - 纤溶系统标志物检测及其临床意义

doi:10.3969/j.issn.1673-8640.2018.08.012

摘要/Abstract

摘要：

目的探讨恶性肿瘤患者血浆血栓调节蛋白（TM）、凝血酶-抗凝血酶复合物（TAT）、纤溶酶-α2抗纤溶酶复合物（PIC）、组织型纤溶酶原激活剂-纤溶酶原激活物抑制剂-1复合物（t-PAI-C）4项标志物与肿瘤的关系。方法采用化学发光酶免疫法分别检测164例恶性肿瘤患者（恶性肿瘤组,其中81例为呼吸道肿瘤组、83例为消化道肿瘤组）和52名体检健康者（正常对照组）血浆TM、TAT、PIC、t-PAI-C水平,分别比较恶性肿瘤组与正常对照组之间及恶性肿瘤有转移者和恶性肿瘤无转移者之间4项指标的差异。结果恶性肿瘤组TM、TAT、PIC、t-PAI-C水平均明显高于正常对照组（P<0.01）;呼吸道肿瘤组TM、TAT、PIC水平明显高于正常对照组（P<0.01）,而t-PAI-C水平2个组之间差异无统计学意义（P>0.05）;消化道肿瘤组TM、TAT、PIC、t-PAI-C与正常对照组比较差异均有统计学意义（P<0.01）;恶性肿瘤有转移者TAT、PIC、t-PAI-C水平高于恶性肿瘤无转移者（P<0.01）,而TM水平与恶性肿瘤无转移者比较差异无统计学意义（P>0.05）;呼吸道肿瘤组和消化道肿瘤组中恶性肿瘤有转移者的TAT、PIC、t-PAI-C水平明显高于恶性肿瘤无转移者（P<0.01）,TM二者间差异无统计学意义（P>0.05）。结论恶性肿瘤患者存在不同程度血管内皮损伤及凝血与纤溶系统功能紊乱。血浆TM、TAT、PIC、t-PAI-C水平可作为恶性肿瘤病情进展、疗效观察及预后判断的指标之一。

关键词: 血栓调节蛋白, 凝血酶-抗凝血酶复合物, 纤溶酶-α2抗纤溶酶复合物;, 组织型纤溶酶原激活剂-纤溶酶原激活物抑制剂-1复合物, 恶性肿瘤

Abstract:

Objective To investigate the relationships of plasma thrombomodulin（TM）,thrombin-antithrombin complex（TAT）,plasmin-alpha 2 plasmin inhibitor complex（PIC） and tissue plasminogen activator-plasminogen activator inhibitor-1 complex（t-PAI-C） with tumors.Methods The levels of plasma TM,TAT,PIC and t-PAI-C were determined by chemiluminescence enzyme immunoassay in 164 malignant tumor patients（81 cases of respiratory tract cancer and 83 cases of gastrointestinal cancer） and 52 healthy subjects（healthy control group）. The difference of plasma TM,TAT,PIC and t-PAI-C between malignant tumor and healthy control groups was evaluated,and the difference between tumor metastasis and non-tumor metastasis groups was analyzed as well.Results The levels of TM,TAT,PIC and t-PAI-C in malignant tumor group were higher than those in healthy control group（P<0.01）. The levels of TM,TAT and PIC in respiratory tract cancer group were higher than those in healthy control group（P<0.01）,and there was no statistical significance for t-PAI-C between the 2 groups（P>0.05）. There was statistical significance for TM,TAT,PIC and t-PAI-C between gastrointestinal cancer group and healthy control group（P<0.01）. In malignant tumor group,TAT,PIC and t-PAI-C were higher in tumor metastasis group than those in non-tumor metastasis group（P<0.01）,while TM had no statistical significance between the 2 groups（P>0.05）. In respiratory tract cancer and gastrointestinal cancer groups,the levels of TAT,PIC and t-PAI-C in tumor metastasis group were higher than those in non-tumor metastasis group（P<0.01）,while there was no statistical significance for TM（P>0.05）.Conclusions Malignant tumor patients have different degrees of vascular endothelial injury and coagulation-fibrinolytic system disorder. Plasma TM,TAT,PIC and t-PAI-C can be used as indicators for malignant tumor progression,curative effect and prognosis.

Key words: Thrombomodulin, Thrombin-antithrombin complex, Plasmin-alpha 2 plasmin inhibitor complex, Tissue plasminogen activator-plasminogen activator inhibitor-1 complex, Malignant tumor

中图分类号:

R446.1

陈文欣, 李强, 薛赢俊, 邵华卿, 李贞, 陆文倩, 胡晓波. 恶性肿瘤患者凝血 - 纤溶系统标志物检测及其临床意义[J]. 检验医学, 2018, 33(8): 722-726.

CHEN Wenxin, LI Qiang, XUE Yingjun, SHAO Huaqing, LI Zhen, LU Wenqian, HU Xiaobo. Determination of coagulation-fibrinolytic system markers in patients with malignant tumor and its role[J]. Laboratory Medicine, 2018, 33(8): 722-726.

图/表 2

参考文献 20

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组别	例数	TM（ng/mL）	TAT（μg/mL）	PIC（IU/mL）	t-PAI-C（ng/mL）
恶性肿瘤组	164	9.10（7.95~10.68）^*	1.10（0.80~2.20）^*	0.73（0.54~1.08）^*	7.00（5.00~9.08）^*
呼吸道肿瘤组	81	8.90（7.65~10.15）^*	1.10（0.80~1.90）^*	0.71（0.54~1.17）^*	7.00（5.05~8.75）
消化道肿瘤组	83	9.50（8.20~11.20）^*	1.20（0.80~3.10）^*	0.74（0.56~0.97）^*	7.30（4.80~9.5）^*
正常对照组	52	7.85（6.63~9.18）	0.95（0.50~1.40）	0.49（0.39~0.60）	6.45（4.43~7.8）

组别	例数	TM（ng/mL）	TAT（μg/mL）	PIC（IU/mL）	t-PAI-C（ng/mL）
恶性肿瘤组	164	9.10（7.95~10.68）^*	1.10（0.80~2.20）^*	0.73（0.54~1.08）^*	7.00（5.00~9.08）^*
呼吸道肿瘤组	81	8.90（7.65~10.15）^*	1.10（0.80~1.90）^*	0.71（0.54~1.17）^*	7.00（5.05~8.75）
消化道肿瘤组	83	9.50（8.20~11.20）^*	1.20（0.80~3.10）^*	0.74（0.56~0.97）^*	7.30（4.80~9.5）^*
正常对照组	52	7.85（6.63~9.18）	0.95（0.50~1.40）	0.49（0.39~0.60）	6.45（4.43~7.8）

组别	例数	TM（ng/mL）	TAT（μg/mL）	PIC（IU/mL）	t-PAI-C（ng/mL）
恶性肿瘤组
恶性肿瘤无转移者	76	8.95（7.90~10.30）	0.90（0.60~1.35）	0.56（0.43~0.74）	6.10（4.23~8.30）
恶性肿瘤有转移者	88	9.25（8.10~11.25）	1.80（1.00~3.30）^*	0.91（0.70~1.56）^*	7.85（5.63~10.28）^*
呼吸道肿瘤组
恶性肿瘤无转移者	41	8.70（7.65~9.95）	0.90（0.60~1.30）	0.55（0.43~0.69）	6.20（4.60~8.05）
恶性肿瘤有转移者	40	9.05（7.68~10.50）	1.55（1.00~2.90）^*	1.07（0.72~1.56）^*	7.75（5.55~9.88）^*
消化道肿瘤组
恶性肿瘤无转移者	35	9.40（8.30~10.70）	0.90（0.60~1.40）	0.57（0.41~0.82）	6.00（3.10~8.60）
恶性肿瘤有转移者	48	9.55（8.13~11.40）	1.90（1.00~4.28）^*	0.84（0.67~1.58）^*	7.9（5.65~11.08）^*

组别	例数	TM（ng/mL）	TAT（μg/mL）	PIC（IU/mL）	t-PAI-C（ng/mL）
恶性肿瘤组
恶性肿瘤无转移者	76	8.95（7.90~10.30）	0.90（0.60~1.35）	0.56（0.43~0.74）	6.10（4.23~8.30）
恶性肿瘤有转移者	88	9.25（8.10~11.25）	1.80（1.00~3.30）^*	0.91（0.70~1.56）^*	7.85（5.63~10.28）^*
呼吸道肿瘤组
恶性肿瘤无转移者	41	8.70（7.65~9.95）	0.90（0.60~1.30）	0.55（0.43~0.69）	6.20（4.60~8.05）
恶性肿瘤有转移者	40	9.05（7.68~10.50）	1.55（1.00~2.90）^*	1.07（0.72~1.56）^*	7.75（5.55~9.88）^*
消化道肿瘤组
恶性肿瘤无转移者	35	9.40（8.30~10.70）	0.90（0.60~1.40）	0.57（0.41~0.82）	6.00（3.10~8.60）
恶性肿瘤有转移者	48	9.55（8.13~11.40）	1.90（1.00~4.28）^*	0.84（0.67~1.58）^*	7.9（5.65~11.08）^*