宫颈癌患者放疗前、中、后血栓弹力图的检测及临床意义
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摘要
目的:利用血栓弹力图(thrombelastography,TEG)监测宫颈癌患者放疗过程中凝血功能的动态变化,并探讨其临床意义。方法:选取自2017年7月至2018年6月期间来我院放疗科收治的47例无手术条件的初治宫颈癌患者为试验组,对所有宫颈癌患者进行放疗前、中、后TEG动态监测,另选取40例健康女性体检者为正常对照组,行TEG检测,主要观察R、K、Angle、MA及CI值的变化,通过对比分析放疗对宫颈癌患者凝血功能的影响。结果:宫颈癌组放疗前与对照组比较,TEG参数K值显著减小,Angle、MA、CI值显著增大,差异具有统计学意义(P<0.01),而R值两组间无显著统计学差异(P>0.05)。宫颈癌组放疗中、放疗后与放疗前比较:放疗中K值增大,MA、CI值均减小,差异具有统计学意义(P<0.05),R值、Angle值两组间差异无统计学意义(P>0.05);放疗后R、K值增大,Angle、MA及CI值减小,差异均具有统计学意义(P<0.01)。宫颈癌组放疗后与放疗中比较:放疗后R、K值增大,Angle、CI值减小,差异具有统计学意义(P<0.05),MA值两组间差异无统计学意义(P>0.05)。结论:宫颈癌患者血液呈现高凝状态,而放疗可改善宫颈癌患者的高凝状态,动态监测宫颈癌放疗期间TEG可为临床提供有价值的凝血信息,对降低放疗期间相关并发症有积极的临床意义。
Objective:Thrombelastography(TEG)was used to monitor the dynamic changes of coagulation function in patients with cervical cancer during radiotherapy,and to explore its clinical significance.Methods:Forty-seven patients with newly diagnosed cervical cancer who had no surgical conditions admitted to our hospital from July 2017 were selected as the experimental group.All patients with cervical cancer were monitored for TEG dynamics before,during and after radiotherapy.Another 40 healthy women were selected as normal control group.TEG test was performed to observe the changes of R,K,Angle,MA and CI values.The effects of radiotherapy on coagulation function of cervical cancer patients were analyzed by contrast analysis.Results:Compared with the control group,the K value of TEG parameters in cervical cancer group before radiotherapy was decreased significantly,and the Angle,MA,and CI values were increased significantly,and the difference was statistically significant(P<0.01),while the R value had no significant difference between the two groups(P>0.05).Cervical cancer group during radiotherapy and after radiotherapy compared with before radiotherapy showed the K value increased,the MA and CI values decreased during radiotherapy,and the difference was statistically significant(P<0.05).There was no significant difference between the two groups in the R value and the Angle value(P>0.05).After radiotherapy,the values of R and K were increased,Angle,MA and CI were decreased,and the differences were statistically significant(P<0.01).Cervical cancer group after radiotherapy compared with during radiotherapy showed the values of R and K increased,and the values of Angle and CI decreased.The difference was statistically significant(P<0.05).There was no significant difference in MA between the two groups(P>0.05).Conclusion:The blood of patients with cervical cancer is hypercoagulable,and radiotherapy can improve the hypercoagulable state of patients with cervical cancer.Dynamic monitoring of TEG during cervical cancer radiotherapy can provide valuable clinical coagulation information,which has positive clinical significance for reducing related complications during radiotherapy.
Objective:Thrombelastography(TEG)was used to monitor the dynamic changes of coagulation function in patients with cervical cancer during radiotherapy,and to explore its clinical significance.Methods:Forty-seven patients with newly diagnosed cervical cancer who had no surgical conditions admitted to our hospital from July 2017 were selected as the experimental group.All patients with cervical cancer were monitored for TEG dynamics before,during and after radiotherapy.Another 40 healthy women were selected as normal control group.TEG test was performed to observe the changes of R,K,Angle,MA and CI values.The effects of radiotherapy on coagulation function of cervical cancer patients were analyzed by contrast analysis.Results:Compared with the control group,the K value of TEG parameters in cervical cancer group before radiotherapy was decreased significantly,and the Angle,MA,and CI values were increased significantly,and the difference was statistically significant(P<0.01),while the R value had no significant difference between the two groups(P>0.05).Cervical cancer group during radiotherapy and after radiotherapy compared with before radiotherapy showed the K value increased,the MA and CI values decreased during radiotherapy,and the difference was statistically significant(P<0.05).There was no significant difference between the two groups in the R value and the Angle value(P>0.05).After radiotherapy,the values of R and K were increased,Angle,MA and CI were decreased,and the differences were statistically significant(P<0.01).Cervical cancer group after radiotherapy compared with during radiotherapy showed the values of R and K increased,and the values of Angle and CI decreased.The difference was statistically significant(P<0.05).There was no significant difference in MA between the two groups(P>0.05).Conclusion:The blood of patients with cervical cancer is hypercoagulable,and radiotherapy can improve the hypercoagulable state of patients with cervical cancer.Dynamic monitoring of TEG during cervical cancer radiotherapy can provide valuable clinical coagulation information,which has positive clinical significance for reducing related complications during radiotherapy.
引文
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[13] Yang L,Lv Y.Possible risk factors associated with radiationproctitis or radiation cystitis in patients with cervical carcinoma after radiotherapy[J].Asian Pac J Cancer Prev,2012,13(12):6251-6255.
[14] Kirchheiner K,Potter R,Tanderup K,et al.Health-related quality of life in locally advanced cervical cancer patients after definitive chemoradiation therapy including imageguided adaptive brachytherapy:An analysis from the EMBRACE study[J].Int J Radiat Oncol Biol Phys,2016,94(5):1088-1098.
[15] Liu Q,Wang W.Talking about the new progress of clinical treatment of cervical cancer[J].The Journal of Practical Medicine,2018,34(1):5-7.[刘倩,王玮.浅谈宫颈癌临床治疗新进展[J].实用医学杂志,2018,34(1):5-7.]
[16] Timp JF,Braekkan SK,Versteeg HH,et al.Epidemiology of cancer-associated venous thrombosis[J].Blood,2013,122(10):1712-1723.
[2] He Hongfen.Clinical observation of the change of blood coagulation in patients after gynecological tumor surgery[J].Journal of Kunming Medical University,2016,37(1):90-93.
[3] Wu HX,Zhang X.Clinical application of thromboelastography in coagulation system[J].Microcirculation Journal,2015,25(3):76-78.
[4] Zhang TY,Wang YQ,Wang JL.Progress in clinical management of stage Ⅱ endometrial cancer[J].International Journal of Obstetrics,2017,44(04):390-395.[张天宇,王益勤,王健六.Ⅱ期子宫内膜癌临床处理进展[J].国际妇产科学杂志,2017,44(04):390-395.]
[5] Hu SZ.Changes of blood coagulation,fibrinolysis and platelet parameters before and after interventional therapy in patients with lung cancer and their clinical significance[J].Chinese Medical Innovation,2015,12(7):58-60.
[6] Zhao X,Cui L,Wang W,et al.Influence of psychological intervention on pain and immune functions of patients receiving lung cancer surgery[J].Pak J Med Sci,2016,32(1):155-159.
[7] Wang J,Liao H,Fu W.Study on the changes of coagulation,fibrinolysis,platelet and tumor markers in patients with advanced lung cancer by chemotherapy[J].Chinese Journal of Biochemical Drugs,2015,35(7):116-118,121.
[8] Yamashita Y.Hypercoagulable state in cancer[J].Rinsho Byori,2015,63(12):1435-1442.
[9] Du B.Significance of detecting coagulation parameters in patients with malignant tumors[J].Contemporary Medicine,2016,14(9):146-148.[杜宝.对恶性肿瘤患者进行凝血指标检测的意义[J].当代医药论丛,2016,14(9):146-148.]
[10] Zhang L,Zhang Y.Changes of blood coagulation,fibrinolysis index and platelet parameters in patients with cervical cancer and their clinical significance[J].Thrombosis and Hemostasis,2018,24(2):246-247.[张莉,张莹.宫颈癌患者凝血、纤溶指标、血小板参数变化及其临床意义[J].血栓与止血学,2018,24(2):246-247.]
[11] Krenn-pilko S,Langsenlehner U,Stojakovic T,et al.An elevated preoperative plasma Fibrinogen level is associated with poor disease-specific and overall survival in breast cancer patients[J].Breast,2015,24(5):667-672.
[12] Zou LF,Zhu Q,Cheng YM,et al.Study on anticoagulant function in patients with hematological malignancies[J].Thrombosis and Hemostasis,2013,19(6):257-260.[邹丽芳,朱琦,程毅敏,等.血液系统恶性肿瘤患者止凝血功能的研究[J].血栓与止血学,2013,19(6):257-260.]
[13] Yang L,Lv Y.Possible risk factors associated with radiationproctitis or radiation cystitis in patients with cervical carcinoma after radiotherapy[J].Asian Pac J Cancer Prev,2012,13(12):6251-6255.
[14] Kirchheiner K,Potter R,Tanderup K,et al.Health-related quality of life in locally advanced cervical cancer patients after definitive chemoradiation therapy including imageguided adaptive brachytherapy:An analysis from the EMBRACE study[J].Int J Radiat Oncol Biol Phys,2016,94(5):1088-1098.
[15] Liu Q,Wang W.Talking about the new progress of clinical treatment of cervical cancer[J].The Journal of Practical Medicine,2018,34(1):5-7.[刘倩,王玮.浅谈宫颈癌临床治疗新进展[J].实用医学杂志,2018,34(1):5-7.]
[16] Timp JF,Braekkan SK,Versteeg HH,et al.Epidemiology of cancer-associated venous thrombosis[J].Blood,2013,122(10):1712-1723.