收稿日期: 2023-06-27
网络出版日期: 2023-12-18
基金资助
国家自然科学基金面上项目(82072876)
The application value of determination of hemostasis and thrombosis in tumor patients
Received date: 2023-06-27
Online published: 2023-12-18
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。
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 . DOI: 10.16150/j.1671-2870.2023.04.003
Abnormal coagulation function is an important feature of the occurrence and development of malignant tumors. Tumor cells release pro-angiogenic factors that cause vascular endothelial damage and induce platelet activation and proliferation, all of which increase the risk of thrombosis. Cancer patients often present with shortened APTT and PT, elevated fibrinogen, D-dimer and platelet counts, and a hypercoagulable state. With thrombosis forms, the fibrinolytic system is activated, and D-dimer and fibrin degradation product (FDP) increase. Both are commonly used markers of the fibrinolytic system. FDP/D-dimer ratio may improve the accuracy of diagnosing thrombosis or bleeding. New coagulation markers, such as platelet function and platelet surface markers, can be used to assess platelet activation. During the hypercoagulable state and the fibrinolysis process of tumors, four new thrombosis factors are discovered: thrombin-antithrombin (TAT), plasmin α2-plasmin inhibitor complex (PIC), tissue plasminogen activator-inhibitor 1 complex (t-PAIC) and thrombomodulin, which can be used as diagnostic markers for malignant tumors and thrombosis. Thromboelastography simultaneously reflects coagulation factor activity, fibrinogen activity, platelet counts and function, and demonstrates the overall dynamic process of coagulation and fibrinolysis. The 6 traditional coagulation tests combined with platelet count, the 4 new thrombosis tests combined with D-dimer and FDP tests, as well as various thrombosis risk assessment models, play an important role in the prognosis assessment of different tumors. With the development of artificial intelligence and new indicators, the application prospects of coagulation abnormality detection will be broader.
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