外科理论与实践

外科理论与实践 ›› 2021, Vol. 26 ›› Issue (04): 361-366.doi: 10.16139/j.1007-9610.2021.04.015

• 论著 • 上一篇    下一篇

结肠直肠癌病人D-二聚体升高的研究

茅届齐a, 徐多刚a, 张米粒b, 肖蕴誉c, 明旭a, 李雨哲b, 曹灿b, 于亮b(), 李继坤b()   

  1. a.南京医科大学附属上海一院临床医学院血管外科,上海 201620
    b.南京医科大学附属上海一院临床医学院胃肠外科,上海 201620
    c.南京医科大学附属上海一院临床医学院麻醉科,上海 201620
  • 收稿日期:2021-02-07 出版日期:2021-07-25 发布日期:2022-08-02
  • 通讯作者: 于亮,李继坤 E-mail:jkli65975@163.com;liang.yu@shgh.cn
  • 基金资助:
    国家自然科学基金(81472236)

Study on D-dimer elevation in patients with colorectal cancer

MAO Jieqia, XU Duoganga, ZHANG Milib, XIAO Yunyuc, MING Xua, LI Yuzheb, CAO Canb, YU Liangb(), LI Jikunb()   

  1. a. Department of Vascular Surgery,Shanghai General Hospital of Nanjing Medical University, Shanghai 201620, China
    b. Department of Gastrointestinal Surgery, Shanghai General Hospital of Nanjing Medical University, Shanghai 201620, China
    c. Department of Anesthesia, Shanghai General Hospital of Nanjing Medical University, Shanghai 201620, China
  • Received:2021-02-07 Online:2021-07-25 Published:2022-08-02
  • Contact: YU Liang,LI Jikun E-mail:jkli65975@163.com;liang.yu@shgh.cn

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摘要：

目的：通过分析结肠直肠癌（colorectal cancer, CRC）病人凝血状态和相关临床资料,探索CRC与机体高凝的关系。方法：收集我院胃肠外科2018年8月至2019年12月手术治疗CRC病人的临床病理资料。以术前外周血D-二聚体水平为评估机体高凝状态的指标,回顾性分析影响CRC病人机体高凝状态发生的相关因素。结果：249例中104例（41.8%）术前血清D-二聚体高于正常上限（>550 μg/L）。其中27例（10.8%）术前D-二聚体显著升高（高于正常上限的3倍,即>1 650 μg/L）。术后发生静脉血栓栓塞（venous thromboembolism, VTE）7例。多因素分析显示,肿瘤远处转移及脉管内肿瘤侵犯是术前D-二聚体升高的相关因素。肿瘤远处转移病人与无远处转移的术前D-二聚体异常升高占比分别为73.3%、37.6%（P<0.01）。脉管内肿瘤侵犯者和无脉管内肿瘤侵犯者术前D-二聚体异常升高占比分别为51.9%、34.3%（P<0.01）。按术前D-二聚体分组,正常组、升高组、显著升高组出现肿瘤远处转移的比例分别为2.8%、6.5%、22.2%,病理检查证实的脉管内肿瘤侵犯的比例分别为35.2%、48.1%、66.7%。两个比例都随术前D-二聚体水平升高而上升。3组VTE事件发生率分别为0.7%、3.9%、11.1%。VTE发生率与术前D-二聚体水平呈正相关。结论：肿瘤远处转移及脉管内肿瘤侵犯是导致CRC病人机体高凝状态的重要因素,可作为VTE风险的预测指标。

关键词: 结肠直肠癌, 血栓栓塞, 静脉血栓形成, 转移, D-二聚体

Abstract:

Objective To analyze the association of coagulation with clinical parameters in patients with colorectal cancer. Methods Clinical and pathological data in the patients with colorectal cancer and surgical treatment were collec-ted from August 2018 to December 2019 in the Department of Gastrointestinal Surgery in our hospital. Retrospective analysis was performed to study the related factors to hypercoagulability with preoperative D-dimer value as index. Results A total of 104 from 249 (41.8%) cases exhibited elevated D-dimer (>550 μg/ L) in serum preoperatively. Twenty-seven (10.8%) cases had a significant elevation of D-dimer(>1 650 μg/ L) three times higher than normal limit. There were 7 cases with venous thromboembolism(VTE) postoperatively. Multivariate analysis showed that the preoperative elevated D-dimer in serum was associated with far metastasis and intraluminal invasion. Elevated D-dimer was found 73.3% cases with metastasis and 37.6% cases without metastasis(P<0.01), and 51.9% cases with intraluminal invasion and 34.3% without intraluminal invasion (P<0.01). Far metastasis was seen 2.8% in cases with normal D-dimer, 6.5% with elevated D-dimer, and 22.2% with significantly elevated D-dimer, and intraluminal tumor invasion diagnosed pathologically 35.2%, 48.1% and 66.7% in patients with normal, elevated and significantly elevated D-dimer, respectively. The incidence of VTE was 0.7%, 3.9% and 11.1% in above three groups, which showed the statistical correlation of VTE with preoperative serum D-dimer level. Conclusions Far metastasis and intraluminal tumor invasion are important to induce hypercoagulability state in patients with colorectal cancer and to be as risk predictor of VTE.

Key words: Colorectal cancer, Thromboembolism, Venous thrombosis, Metastasis, D-dimer

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