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目的低分子肝素钠联合化疗治疗晚期非小细胞肺癌,观察患者血液高凝状态的变化、静脉血栓症(venous thromboembolism,VTE)的发生率、临床疗效变化及出血风险。方法选取2013年9月—2015年2月间收治的189例晚期非小细胞肺癌患者随机分为对照组(单纯化疗)62例、低剂量组(低分子肝素钠5 000U 1次/d+化疗)64例和标准剂量组(低分子肝素钠5 000U 12 h/次+化疗)63例,每组患者化疗周期数为4~6个。观察三组间凝血功能指标的变化、静脉血栓症的发生率、临床疗效及出血概率。计量资料采用方差分析,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果三组间治疗后APTT、PT均值无显著变化,对比差异均无统计学意义(均P>0.05)。三组D-二聚体均值分别是(0.95±0.20)、(0.28±0.12)、(0.25±0.15)mg/L,对比差异均有统计学意义(均P<0.05)。Fig均值分别是(4.68±1.23)、(2.56±0.85)、(2.69±0.78)g/L,对比差异均有统计学意义(均P<0.05)。三组血栓发生率分别是17.74%、6.25%和4.76%,对比差异均有统计学意义(均P<0.05)。三组间临床有效率分别是35.5%、40.6%和42.9%,三组间出血概率分别是9.68%、12.5%和14.3%,对比差异均有统计学意义(均P>0.05)。结论低分子肝素钠联合化疗可以纠正晚期非小细胞肺癌患者的高凝状态,降低VTE的发生概率,有提高临床近期有效率的趋势,出血风险无显著增加,低剂量低分子肝素钠疗效相当。
Objective To investigate the changes of blood hypercoagulability, the incidence of venous thromboembolism (VTE), the change of clinical efficacy and the risk of bleeding in patients with advanced non-small cell lung cancer treated with LMWH combined with chemotherapy. Methods A total of 189 patients with advanced non-small cell lung cancer who were treated in our hospital from September 2013 to February 2015 were randomly divided into control group (chemotherapy alone), 62 cases, low dose group (low molecular weight heparin 5000U / time plus chemotherapy) 64 cases and standard dose group (low molecular weight heparin 5 000U 12 h / times + chemotherapy) 63 cases, each group of patients with cycles of 4 to 6. The change of coagulation function, the incidence of venous thrombosis, clinical efficacy and bleeding probability were observed. Measurement data using analysis of variance, count data using χ2 test, P <0.05 for the difference was statistically significant. Results There was no significant difference in APTT and PT between the three groups after treatment (all P> 0.05). The mean values of D-dimer in three groups were (0.95 ± 0.20), (0.28 ± 0.12) and (0.25 ± 0.15) mg / L, respectively. The differences were statistically significant (all P <0.05). (4.68 ± 1.23), (2.56 ± 0.85) and (2.69 ± 0.78) g / L, respectively. There was significant difference between the two groups (all P <0.05). The thrombosis rates of the three groups were 17.74%, 6.25% and 4.76%, respectively, with significant differences (all P <0.05). The clinical efficacy rates of the three groups were 35.5%, 40.6% and 42.9%, respectively. The hemorrhagic probabilities of the three groups were 9.68%, 12.5% and 14.3% respectively, with statistical significance (all P> 0.05). Conclusion Low molecular weight heparin combined with chemotherapy can correct the hypercoagulable state, reduce the incidence of VTE in patients with advanced non-small cell lung cancer, improve the clinical efficacy of the recent trend, no significant increase in the risk of bleeding, low dose of low molecular weight heparin sodium efficacy.