【摘要】 目的寻找早期胰腺癌患者术后静脉血栓栓塞(VTE)的生物标志物,以便合理运用抗凝药物减少血栓事件。方法回顾性分析2016年4月至2018年4月我院收治的81例早期胰腺癌患者,根据术后是否发生VTE分为VTE组和非VTE组,对比分析两组的临床数据以及实验室参数,分析凝血酶/抗凝血酶Ⅲ复合物(TAT-Ⅲ)、凝血酶原片段(F1+2)和D-二聚体之间的相关性。分析D-二聚体、TAT-Ⅲ、F1+2对早期胰腺癌术后VTE的评估价值,探讨三者联合检测的评估价值。结果纳入非VTE组62例,VTE组19例,其中6例诊断为肺栓塞(PE),另有31. 6%(6/19)的VTE事件发生在出院后,均诊断为DVT。VTE组D-二聚体、TAT-Ⅲ、F1+2在显著高于非VTE组(P <0. 01),VTE组的Caprini评分、住院时间和死亡率均显著高于非VTE组(P <0. 05)。在VTE事件发生时间上,PE患者较DVT患者显著提前(P <0. 01),PE患者住院时间和Caprini评分均显著高于DVT患者(P <0. 05)。TAT-Ⅲ、F1+2均与D-二聚体之间呈正相关(r=0. 731,0. 559,P <0. 001)。D-二聚体、TAT-Ⅲ、F1+2对VTE均有一定对预测价值,AUC分别为0. 848(95%CI 0. 749～0. 947)、0. 880(95%CI 0. 797～0. 964)、0. 895(95%CI 0. 813～0. 973)。D-二聚体、TAT-Ⅲ、F1+2联合检测对VTE预测的敏感度和特异度分别为94. 7%和79. 0%; kappa值为0. 605,高于单项检测指标。结论 D-二聚体、TAT-Ⅲ和F1+2可以作为早期检测胰腺癌患者术后发生VTE的生物学标记物,联合检测具有更高的敏感度。更多还原

【Abstract】 Objective To search for biomarkers of postoperative venous thromboembolism( VTE) in patients with early pancreatic cancer in order to rationally use anticoagulant drugs to reduce thrombotic events. Methods A retrospective analysis of 81 patients with early stage pancreatic cancer admitted to our hospital from April 2016 to April 2018 was divided into VTE group and nonVTE group according to whether VTE occurred after operation. The clinical data and laboratory parameters of the two groups were compared and analyzed. The correlation between thrombin/antithrombin Ⅲ complex( TAT-Ⅲ),prothrombin fragment( F1 + 2) and Ddimer was analyzed. To evaluate the value of D-dimer,TAT-Ⅲ and F1 + 2 in the evaluation of postoperative VTE in patients with early pancreatic cancer,and the evaluation value of the combined detection of the three. Results 62 patients in the non-VTE group and 19 patients in the VTE group were enrolled. 6 of them were diagnosed with pulmonary embolism( PE),and another 31. 6%( 6/19) of the VTE events were diagnosed as DVT after discharge. The D-dimer,TAT-Ⅲ and F1 + 2 in the VTE group were significantly higher than those in the non-VTE group( P < 0. 01). The Caprini score,hospitalization time and mortality in the VTE group were significantly higher than those in the non-VTE group( P < 0. 05). In the time of VTE event,PE patients were significantly earlier than DVT patients( P < 0. 01),PE patients’ hospitalization time and Caprini score were significantly higher than DVT patients( P < 0. 05). There was a positive correlation between TAT-Ⅲ and F1 + 2 and D-dimer( r = 0. 731,0. 559,P < 0. 001). D-dimer,TAT-Ⅲ,and F1 + 2 have certain predictive value for VTE,with AUC of 0. 848( 95% CI 0. 749 ～ 0. 947),0. 880( 95% CI 0. 797 ～ 0. 964),and 0. 895( 95%CI). 0. 813 ～ 0. 973). The sensitivity and specificity of D-dimer,TAT-Ⅲ and F1 + 2 combined detection for VTE prediction were94. 7% and 79. 0%,respectively; kappa value was 0. 605,which was higher than single detection index. Conclusion D-dimer,TAT-Ⅲ and F1 + 2 can be used as biomarkers for early detection of VTE in patients with pancreatic cancer. Combined detection has higher sensitivity.更多还原