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目的肿瘤患者体内凝血系统异常活化,而糖尿病患者体内也存在多种促凝和抗凝成分的改变。本研究探讨结直肠癌(colorectal cancer,CRC)合并2型糖尿病(type 2diabetes mellitus,T2DM)以及单纯CRC患者血浆纤维蛋白原(fibrinogen,FIB)和D-二聚体(D-dimer)的变化,及FIB、D-dimer与CRC合并T2DM患者临床病理特征之间的关系。方法选取2011-03-07-2015-09-25天津市人民医院住院患者1 141例。分为合并组274例和CRC组867例,合并组为CRC合并T2DM患者,CRC组为单纯CRC患者。检测空腹血糖(Glu)、FIB和D-dimer,比较两组差异。应用单因素方差分析和t检验比较患者不同临床病理特征FIB水平的差异,应用非参数检验比较患者不同临床病理特征D-dimer水平的差异。结果合并组FIB水平为(4.16±1.066)g/L,高于CRC组的(3.96±0.935)g/L,t=-2.727,P=0.007;合并组D-dimer水平为0.38(0.26,0.67)mg/L,CRC组D-dimer水平为0.40(0.26,0.66)mg/L,两者比较差异无统计学意义,Z=0.168,P=0.867。合并组肿瘤长径≥5cm者FIB(4.41±1.03)g/L高于肿瘤长径<5cm者(3.87±1.01)g/L,t=-3.946,P<0.001;pT_(3-4)期肿瘤患者FIB(4.21±1.04)g/L高于pT_1~T_2期的(3.78±1.01)g/L,t=-2.295,P=0.023;低、中分化患者FIB水平(4.70±1.00、4.20±1.03)g/L高于高分化患者(3.83±1.10)g/L,F=4.262,P=0.015。合并组女性D-dimer水平0.51(0.32,1.08)mg/L高于男性0.34(0.26,0.55)mg/L,Z=3.797,P<0.001;结肠癌患者D-dimer水平0.47(0.31,0.78)mg/L高于直肠癌患者0.34(0.26,0.61)mg/L,Z=2.492,P=0.013;pT_3~T_4期患者D-dimer水平0.39(0.26,0.72)mg/L高于pT_1~T_2期者0.32(0.24,0.42)mg/L,Z=2.090,P=0.037。结论 CRC合并T2DM患者血液处于高凝状态。CRC合并T2DM患者术前高FIB和D-dimer水平与较大的肿瘤直径和较差的肿瘤病理分期、分化有关。
The purpose of the tumor in patients with abnormal activation of the coagulation system, while patients with diabetes also have a variety of procoagulant and anticoagulant changes. This study was aimed to investigate the changes of plasma fibrinogen (FIB) and D-dimer in colorectal cancer (CRC) patients with type 2 diabetes mellitus (T2DM) and simple CRC, And FIB, D-dimer and CRC combined with clinicopathological features of T2DM patients. Method selection 2011-03-07-2015-09-25 Tianjin People’s Hospital 1 141 cases of inpatients. Divided into the combined group of 274 cases and CRC group of 867 cases, the combined group was CRC combined with T2DM patients, CRC group was simple CRC patients. Fasting blood glucose (Glu), FIB and D-dimer were measured and compared between the two groups. One-way analysis of variance and t-test were used to compare the differences in FIB levels between different clinical and pathological features. Non-parametric tests were used to compare the differences in D-dimer levels between different clinicopathological features. Results The FIB level in the combined group was (4.16 ± 1.066) g / L, higher than that in the CRC group (3.96 ± 0.935) g / L, t = -2.727, P = 0.007. The D-dimer level in the combined group was 0.38 ) mg / L. The D-dimer level in CRC group was 0.40 (0.26,0.66) mg / L, with no significant difference between the two groups (Z = 0.168, P = 0.867). The FIB (4.41 ± 1.03) g / L was significantly higher in the combined group than those with the diameter of 5 cm or more (3.41 ± 1.03 g / L vs 3.87 ± 1.01 g / L, t = -3.946, The FIB level in tumor patients was 4.21 ± 1.04 g / L, which was significantly higher than that in pT_1 -T_2 patients (3.78 ± 1.01) g / L, t = -2.295, P = 0.023. 1.03) g / L was higher than that in well-differentiated patients (3.83 ± 1.10) g / L, F = 4.262, P = 0.015. The D-dimer level in the combined group was 0.51 (0.32,1.08) mg / L higher than that in the male (0.26,0.55) mg / L, Z = 3.797, P <0.001; mg / L was higher than that in patients with rectal cancer (0.34,0.26,0.61) mg / L, Z = 2.492, P = 0.013. The level of D-dimer in patients with pT_3 ~ T_4 was significantly higher than that in patients with pT_1 ~ 0.32 (0.24, 0.42) mg / L, Z = 2.090, P = 0.037. Conclusion CRC patients with T2DM are hypercoagulable. Preoperative high FIB and D-dimer levels in patients with CRC complicated with T2DM are associated with a larger tumor diameter and poorer tumor stage and differentiation.