肺癌合并静脉血栓栓塞危险因素及预后的临床分析-外科学专业论文.docxVIP

万方数据 万方数据 目 录 中文摘要················································································1 英文摘要················································································5 研究生论文 肺癌合并静脉血栓栓塞危险因素及预后的临床分析 前言············································································10 材料与方法···································································12 结果·············································································14 附表··············································································17 附图·············································································18 讨论···············································································22 结论···············································································30 参考文献·········································································31 综述·····················································································37 致谢··················································································51 个人简历·············································································52 中 中 文 摘 要 PAGE 10万方数据 PAGE 10 万方数据 肺癌合并静脉血栓栓塞危险因素及预后的临床分析 摘 要 目的：恶性肿瘤合并静脉血栓栓塞与血小板的激活存在着密切联系， 恶性肿瘤激活血小板触发一系列凝血反应导致血液呈高凝状态进而形成 栓塞，亦或是血小板自身因素的激活导致血液呈高凝状态，还未有完全 明确的阐述，恶性肿瘤和血小板之间存在相互作用。静脉血栓栓塞发生 的血液基础是恶性肿瘤的血液高凝状态。恶性肿瘤导致血液高凝状态的 机制及原因有很多，包括恶性肿瘤对血小板的激活和恶性肿瘤细胞本身 可分泌释放促凝物质如组织因子以及癌促凝物等物质来激活凝血等。恶 性肿瘤细胞本身就可以激活小板并诱导血小板聚集，称之为“癌细胞诱导 的血小板聚集”，进而导致高凝状态。而同时血小板的激活对循环肿瘤细 胞的形成、存活、锚定与转移又起到了保护作用和提供了便利条件。恶 性肿瘤患者机体常处于高凝状态，这种状态使恶性肿瘤患者易形成静脉 血栓栓塞,还对肿瘤细胞的增值、浸润与转移又促进作用。尤其外周血中 的循环肿瘤细胞（CTCs）是肿瘤转移和复发的根源，也是恶性肿瘤导致 外周血液处于高凝状态的原因。高凝状态与肿瘤复发、转移关系密切， 直接影响着患者的预后。血栓性疾病已成为恶性肿瘤患者第二大死亡原 因，因为血液处于高凝状态可导致多种凝血因子及血细胞的激活，对肿 瘤细胞起到保护作用，促进了恶性肿瘤的复发与转移，而同时恶性肿瘤 在其侵袭、浸润、转移的过程中常可激活血小板及凝血因子，促进了静 脉血栓栓塞的形成，所以静脉血栓栓塞多提示肿瘤患者预后不良。恶性 肿瘤患者静脉栓塞症的发生率明显高于一般人群,其中包括肺癌、胰腺癌、 胃肠道肿瘤、卵巢癌等，肺癌居于恶性肿瘤合并静脉血栓栓塞发生率之 首，肺癌患者是恶性肿瘤患者中发病率最高的，同时其导致的病死率也 特别高。肺癌可通过多种复杂的作用机制破坏机体内凝血系统与抗凝血 系统及纤溶系统之间的动态平衡，进而使机体呈现高凝状态，甚至形成 栓塞，肺癌合并静脉血栓栓塞的发生率根据肺癌的不同病理类型和分期