诊断学理论与实践 ›› 2023, Vol. 22 ›› Issue (04): 341-347.doi: 10.16150/j.1671-2870.2023.04.003
收稿日期:
2023-06-27
出版日期:
2023-08-25
发布日期:
2023-12-18
通讯作者:
卢仁泉 E-mail:基金资助:
Received:
2023-06-27
Online:
2023-08-25
Published:
2023-12-18
摘要:
出凝血功能异常是恶性肿瘤发生、发展的重要特征。肿瘤细胞释放促血管生成因子引起血管内皮损伤,并诱导血小板活化和增多,均增加了血栓形成的风险。肿瘤患者常表现为活化部分凝血活酶时间(activated partial thromboplastin time,APTT)和凝血酶原时间(prothrombin time,PT)缩短,纤维蛋白原、D-二聚体水平和血小板计数增高,呈现高凝状态。血栓形成的同时,纤溶系统激活,D-二聚体和纤维蛋白降解产物(fibrin degradation product, FDP)升高,两者是纤溶系统常用标志物,计算FDP/D-二聚体比值,可提高诊断血栓或出血的准确率。血小板功能及血小板表面标志物等新型出凝血标志物,可用于评估血小板活化状况。在肿瘤高凝状态和纤溶过程中,血栓新4项[凝血酶-抗凝血酶复合物(thrombin-antithrombin, TAT)、纤溶酶α2纤溶酶抑制物复合物(plasmin-α2-plasmin inhibitor complex, PIC)、组织纤溶酶原激活物-抑制剂1复合物(tissue plasminogen activator-inhibitor 1 complex, t-PAIC)和血栓调节蛋白]可作为恶性肿瘤和血栓形成的诊断标志物。血栓弹力图可同时反映凝血因子活性、纤维蛋白原活性、血小板数量和功能,展示了凝血与纤溶的整体动态过程。传统凝血6项与血小板计数联检、血栓新4项联合D-二聚体、FDP检测,以及多种血栓风险评估模型,在不同肿瘤的预后评估中发挥着重要作用。随着人工智能和新标志物的发展,出凝血异常检测的应用前景将更为广阔。
中图分类号:
王砚春, 卢仁泉. 出凝血检测在肿瘤患者中的应用价值探讨[J]. 诊断学理论与实践, 2023, 22(04): 341-347.
WANG Yanchun, LU Renquan. The application value of determination of hemostasis and thrombosis in tumor patients[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(04): 341-347.
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