肺癌患者围手术期血浆D-二聚体水平变化分析

【摘要】目的 探讨肺癌患者血浆D-二聚体水平在围手术期的变化规律，及其与肺癌临床病理特征间的关系。方法选取手术治疗的64例肺癌患者为肺癌组，同期良性肺病变开胸的15例患者为对照组，测定2组患者术前、术后1d、术后5d及术后9d的血浆D-二聚体水平，结合肺癌临床病理学特征进行统计学分析。结果肺癌组术前血浆D-二聚体水平较对照组明显升高（t=3.087，P＜0.05），TNM分期Ⅰ期者低于Ⅱ期、Ⅲ期（P＜0.05），小细胞癌高于其他病理类型（P＜0.05）；2组围手术期血浆D-二聚体水平均存在随时间变化趋势（P＜0.001），肺癌组自术后第1 天明显升高，术后第5天显著下降，至术后第9天时低于术前水平（各时段两两比较均P＜0.05），对照组自术后第1天明显升高，术后5天与术后第1天持平（P=0.174），术后第9天时下降至术前水平（P=0.631）。肺癌及对照组数据总体存在显著差异（P=0.005），除术后第5天2组间差异无统计学意义外（P=0.069），肺癌组术后各时段血浆D-二聚体水平均高于对照组（术后第1天P=0.009、术后第9天P=0.017）。结论肺癌患者术前血浆D-二聚体水平高于对照组，与TNM分期及细胞类型相关；肺癌患者血浆D-二聚体水平术后1d时明显升高，随后显著下降，至术后9d时低于术前水平，但仍高于同期良性对照组。

Study of perioperative plasma D-dimer levels in patients with lung cancer

Abstract]Objective: To investigate the change pattern of perioperative plasma D-dimer levels in patients with lung cancer, and the relationship of plasma D-dimer level with clinical pathological features. Methods: 64 cases of lung cancer patients were taken as cancer group, and 15 cases of benign lung disease were as control group. The plasma D-dimer was determined two days before operation and the first, fifth, ninth day after operation. The clinical pathological parameters and type of surgery were evaluated at the same time. Results: Plasma D-dimer levels in patients with lung cancer were much higher than those in control group(t=3.087，P＜0.05). D-dimer levels in TNM stageⅠpatients were lower than those in stageⅡor Ⅲ patients(P＜0.05, respectively). Plasma D-dimer levels in small cell cancer patients were higher than non-small cell cancer patients(P＜0.05). D-dimer levels were changing in different time of perioperative period(P＜0.001). In cancer group, D-dimer levels were up-regulated on the first day after operation, and then significantly down-regulated on the fifth and ninth day. D-dimer levels on the ninth day after operation were much lower than levels before operation(pairwise comparison, P＜0.05, respectively). In control group, D-dimer levels were increased on the first day after operation, and were unchanged on the fifth day (P=0.174), then were decreased on the ninth day. And there were no significantly difference between levels on the ninth day after operation with D-dimer levels before operation (P=0.631). D-dimer levels in cancer group and control group were significantly different (P=0.005). In addition to the fifth day (P=0.069), postoperative D-dimer levels in cancer group were much higher than control group (the first day P=0.009, the ninth day P=0.017). Conclusions: Plasma D-dimer levels before operation in patients with lung cancer were much higher than those in benign lung disease, and were associated with TNM stage and cell type. D-dimer levels in lung cancer patients were significantly increased from the first day after operation, and then decreased significantly until the ninth day, which were lower than D-dimer levels before operation. But they were still higher than benign lung disease patients at the same time interval.