摘要
目的 探讨淋巴瘤患者凝血和纤溶指标检测的临床价值.方法 回顾性分析2013年1月至2017年9月厦门大学附属中山医院收治的初诊淋巴瘤患者115例.根据2008年世界卫生组织淋巴瘤诊断及疗效标准,将患者分为化疗缓解组(76例)和化疗未缓解组(39例).选取同期体检健康者138名作为健康对照组.检测所有受试者D-二聚体(D-D)、血管性血友病因子抗原(vWF:Ag)、凝血因子Ⅶ(FⅦ)和血清乳酸脱氢酶(LDH)等凝血和纤溶指标水平.采用Kruskal-Wallis法比较淋巴瘤分期及治疗结果分层患者间凝血和纤溶指标的差异;采用Spearman相关分析法对D-D与LDH、疾病分期的相关性进行检验;通过受试者工作特征(ROC)曲线分析D-D辅助诊断淋巴瘤并发血栓的效能.结果 淋巴瘤患者血浆D-D、vWF:Ag水平和FⅦ活性[中位数(四分位数间距)]均高于健康对照组[1 240 ng/ml (1 610 ng/ml)比250 ng/ml(43 ng/ml),Z=-10.728,P<0.01;170 ng/ml(113 ng/ml)比105 ng/ml (28 ng/ml),Z=-6.425,P<0.01;120%(26%)比96%(26%),Z=-4.602,P<0.01];随着Ann Arbor分期升高,血浆D-D、vWF:Ag水平和FⅦ活性也逐渐增高(均P<0.05);血浆D-D、vWF:Ag水平及FⅦ活性在淋巴瘤并发血栓组高于未并发血栓组(均P<0.01),D-D和vWF:Ag水平在化疗缓解组均低于化疗未缓解组(均P<0.01).血浆D-D水平与LDH水平、Ann Arbor分期均呈正相关(r值分别为0.414、0.530,均P<0.01).血浆D-D水平为1 735 ng/ml时,诊断淋巴瘤患者是否发生血栓的灵敏度为81.8%,特异度为85.7%,ROC曲线下面积为0.894,约登指数最高(0.675).结论 临床上可通过检测血浆D-D等凝血和纤溶指标评估淋巴瘤患者凝血和纤溶情况,实时监测血浆D-D水平可判断淋巴瘤患者血栓形成趋势,并可能对评估疗效及预后有重要意义.
Objective To investigate the clinical value of blood coagulation and fibrinolysis index detection in lymphoma patients. Methods A total of 115 lymphoma patients hospitalized at Zhongshan Hospital of Xiamen University from January 2013 to September 2017 were retrospectively analyzed. According to the diagnostic and therapeutic criteria of lymphoma from World Health Organization (2008), these patients were divided into chemotherapy remission group (76 cases) and chemotherapy non-remission group (39 cases). A total of 138 healthy examination subjects at the same period were selected as the control group. Coagulation factor Ⅶ (FⅦ), D-dimer (D-D), von Willebrand factor antigen (vWF: Ag) and serum lactate dehydrogenase (LDH) levels were measured in all subjects. Kruskal-Wallis test was used to compare the differences of blood coagulation and fibrinolysis indicators in patients with different lymphoma staging and stratified treatment outcomes. Correlation test of D-D and LDH and disease staging was performed by using Spearman correlation analysis. The receiver operating characteristics (ROC) curve was used to analyze the efficacy of D-D in the assisted diagnosis of lymphoma with thrombosis. Results The plasma D-D, vWF: Ag levels and FⅦ activity [the median (interquartile range)] in lymphoma patients were higher than those in healthy controls [1 240 ng/ml (1 610 ng/ml) vs. 250 ng/ml (43 ng/ml), Z=-10.728, P<0.01;170 ng/ml (113 ng/ml) vs. 105 ng/ml (28 ng/ml), Z=-6.425, P<0.01;120% (26%) vs. 96% (26%), Z= -4.602, P< 0.01]. With the increase of Ann Arbor stage, plasma D-D, vWF: Ag levels and FⅦactivity were also increased gradually (all P<0.05);plasma D-D, vWF: Ag levels and FⅦ activity in lymphoma with thrombosis group were higher than those in the group without thrombosis (all P< 0.01), D-D and vWF: Ag levels in the chemotherapy remission group were lower than those in the chemotherapy non-remission group (all P < 0.01). Plasma D-D levels were positively correlated with LDH level and Ann Arbor stage (r values were 0.414 and 0.530, respectively, all P< 0.01). When the plasma D-D level was 1 735 ng/ml, the sensitivity of diagnosis of thrombosis in patients with lymphoma was 81.8%, the specificity was 85.7%, the area under the ROC curve was 0.894, and the Youden index was the highest (0.675). Conclusions Clinically, blood coagulation and fibrinolysis in patients with lymphoma can be evaluated by detecting blood coagulation and fibrinolysis indexes such as plasma D-D. Real-time monitoring of plasma D-D level can determine the thrombosis trend of lymphoma patients, and it may play an important role in evaluating the efficacy and prognosis.
作者
林晓燕
刘莉莉
周建锋
赵江宁
Lin Xiaoyan;Liu Lili;Zhou Jianfeng;Zhao Jiangning(Department of Clinical Laboratory,Zhongshan Hospital,Xiamen University,Xiamen 361004,China;Department of Hematology,Zhongshan Hospital,Xiamen University,Xiamen 361004,China)
出处
《白血病．淋巴瘤》
CAS
2019年第11期653-657,共5页
Journal of Leukemia & Lymphoma
