小剂量口服沙利度胺对三阴性乳腺癌患者凝血系统功能的影响

摘要

目的：观察三阴性乳腺癌患者服用小剂量沙利度胺前后凝血指标变化，以探讨小剂量沙利度胺是否能增加栓塞事件风险。方法：选取2008年至2012年于中国医科大学附属盛京医院住院的三阴性乳腺癌患者292例，将患者按治疗过程中是否进行化疗分为化疗组（145例）与非化疗组（147例），均给予沙利度胺100mg每日一次口服。服药前和连续服用沙利度胺3个月、6个月后抽取患者外周静脉血，用4色荧光流式细胞仪检测血小板活化程度，自动分析凝血仪检测患者部分凝血活酶时间（APTT）、凝血酶原时间（PT）、纤维蛋白原（FIB）、D -二聚体（DD）。比较患者血小板活化程度、内外源性凝血途径功能变化。结果：收治的292例患者，去除退组的55例，服用沙利度胺前后 APTT、PT 值、血小板活化程度均无显著变化。化疗组服沙利度胺前 FIB 为（3.4±0.92）g/ L，DD 值为（242.7±249.7）μg/ L；服沙利度胺6个月后 FIB 为（3.9±2.4）g/ L （t =-2.48，P =0.021），DD 值为（354.2±236.1）μg/ L（t =-2.1，P =0.047）。FIB、DD 值较前升高，有显著意义。非化疗组 FIB 值较前升高，但无显著意义（t =-1.83，P =0.078），服药前 DD 值为（225.6±156.8）μg/L，之后为（267.3±206.7）μg/ L，升高有显著意义（t =-2.69，P =0.012）。结论：小剂量口服沙利度胺不能影响三阴性乳腺癌患者血小板活化，亦不能影响内外源凝血因子，但有可能增加深静脉血栓发生几率。%To observe the coagulative functional change of TNBC(triple negative breast cancer)pa-tients who take thalidomide 100mg/ d with or without chemotherapy to find whether small dose thalidomide can induce thombosis incidence. Methods:All 292 patients with triple negative breast cancer were divided into chemotherapy group(145 patients)and non - chemotherapy group(147 patients). Treat them with thalidomide 100mg/ d po for half a year,with chemotherapy simultaneously for chemotherapy group. Draw venous blood before and after taking thalido-mide for three months,six months respectively,analyze the platelet activating degree with fluorescence flow cytometer as well as APTT,PT,FIB,DD with automatic coagulative analysator. Results:Both groups'APTT,PT value and plate-let activation didn't change obviously. Chemotherapy group had obvious change in FIB,(3. 4 ± 0. 92)g/ L before,(3. 9 ± 2. 4)g/ L(P = 0. 021)after taking thalidomide for six months,DD(242. 7 ± 249. 7)μg/ L before,(354. 2 ± 236. 1)μg/ L(P = 0. 047)six months later,non - chemotherapy group's mean FIB was higher than before while it didn't show statistical significancy(P = 0. 078). It's DD was higher significantly(P = 0. 012)after taking thalidomide. Conclu-sion:Small dose thalidomide po affect neither endogenous and exogenous coagulative factor nor platelet activation of patients with TNBC. It increases the deep vein thrombotic risk especially taken chemotherapy simutaneously.