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Objective@#To explore the early diagnostic value of thrombus molecular markers in thrombosis ofpatients with malignant tumors and to evaluate their risk factors.@*Methods@#Diagnostic research.A total of 1366 patients (including lung cancer, breast cancer and colorectal cancer,) were randomly selected in the Red Flag Hospital of Mudanjiang Medical College and Mudanjiang Cancer Hospitalfrom September 2009 to February 1919. Among them, 562 were males and 804 were females with average age (59.45±15.10) years old. The control group consisted of 70healthy donors (35 males and 35 females, with an average age of (49.60±19.12) years old), including 69 cases of venous thrombosis (thrombotic group, 32 males and37 females, with an average age of (61.20±15.71) years old).Chemoluminescent enzyme immunoassay was used to detect thromboregulatory proteins(TM), thrombin-antithrombin complexes(TAT), tissue plasminogen activators/inhibitors -1 complexes(t-PAIC), plasminase-anti-fibrinolysis complexes(PIC) in venous plasma. According to the sensitivity and specificity of each marker, the receiver′s work characteristic curve was drawn to evaluate its diagnostic performance. Cox regression analysis was used for single-factor and multi-factor risk analysis.@*Results@#The incidence of venous thromboembolism(VTE) in patients with different types of malignant tumors was statistically significant, with lung cancer being the highest, followed by colorectal cancer and breast cancer(P<0.05). The levels of TM, TAT, t-PAIC and PIC were significantly higher in the lung, breast and colorectal thrombosis group than in the control group. The differences were statistically significant(all P<0.05). The optimal cut-off level for TM is 10.57 IU/ml(sensitivity 50.30%, specificity 75.50%, AUC=0.671), and the optimal cut-off level for TAT is 4.16 ng/ml(sensitivity is 80.30%, specificity is 62.80%, AUC=0.757).The optimal truncation level for t-PAIC is 11.44 ng/ml(sensitivity 52.50%, specificity 84.00%, AUC=0.682), and the optimal truncation level for PIC is 1.18μg/ml(sensitivity 67.20%, specificity is 79.50%, AUC=0.790). The combined detection of the four molecular markers has the best sensitivity and diagnostic performance(86.90%, AUC=0.807). Age, stage, metastasis, surgery, tumor diameter, and PIC levels are independent factors that affect the occurrence of VTE in malignant tumors (all P<0.05).@*Conclusions@#Different types of malignant tumors have different rates of thrombosis. The combined detection ofTM, TAT, t-PAIC and PIC have the best diagnostic performance, and can be used as a new early diagnosis method for VTE in malignant tumors. Age, stage, metastasis, surgery, and tumor diameter are risk factors for VTE in malignant tumors. PIC levels can be used as a reliable markerfor the risk of VTE in patients with malignant tumors within 6 months.
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Objective:To explore the early diagnostic value of thrombus molecular markers in thrombosis ofpatients with malignant tumors and to evaluate their risk factors.Methods:Diagnostic research.A total of 1366 patients (including lung cancer, breast cancer and colorectal cancer,) were randomly selected in the Red Flag Hospital of Mudanjiang Medical College and Mudanjiang Cancer Hospitalfrom September 2009 to February 1919. Among them, 562 were males and 804 were females with average age (59.45±15.10) years old. The control group consisted of 70healthy donors (35 males and 35 females, with an average age of (49.60±19.12) years old), including 69 cases of venous thrombosis (thrombotic group, 32 males and37 females, with an average age of (61.20±15.71) years old).Chemoluminescent enzyme immunoassay was used to detect thromboregulatory proteins(TM), thrombin-antithrombin complexes(TAT), tissue plasminogen activators/inhibitors -1 complexes(t-PAIC), plasminase-anti-fibrinolysis complexes(PIC) in venous plasma. According to the sensitivity and specificity of each marker, the receiver′s work characteristic curve was drawn to evaluate its diagnostic performance. Cox regression analysis was used for single-factor and multi-factor risk analysis.Results:The incidence of venous thromboembolism(VTE) in patients with different types of malignant tumors was statistically significant, with lung cancer being the highest, followed by colorectal cancer and breast cancer( P<0.05). The levels of TM, TAT, t-PAIC and PIC were significantly higher in the lung, breast and colorectal thrombosis group than in the control group. The differences were statistically significant(all P<0.05). The optimal cut-off level for TM is 10.57 IU/ml(sensitivity 50.30%, specificity 75.50%, AUC=0.671), and the optimal cut-off level for TAT is 4.16 ng/ml(sensitivity is 80.30%, specificity is 62.80%, AUC=0.757).The optimal truncation level for t-PAIC is 11.44 ng/ml(sensitivity 52.50%, specificity 84.00%, AUC=0.682), and the optimal truncation level for PIC is 1.18μg/ml(sensitivity 67.20%, specificity is 79.50%, AUC=0.790). The combined detection of the four molecular markers has the best sensitivity and diagnostic performance(86.90%, AUC=0.807). Age, stage, metastasis, surgery, tumor diameter, and PIC levels are independent factors that affect the occurrence of VTE in malignant tumors (all P<0.05). Conclusions:Different types of malignant tumors have different rates of thrombosis. The combined detection ofTM, TAT, t-PAIC and PIC have the best diagnostic performance, and can be used as a new early diagnosis method for VTE in malignant tumors. Age, stage, metastasis, surgery, and tumor diameter are risk factors for VTE in malignant tumors. PIC levels can be used as a reliable markerfor the risk of VTE in patients with malignant tumors within 6 months.
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Objective To investigate the change of the fibrin monomer (FM) level in the venous thromboembolic disease (VTE).To compare the diagnostic value of FM combined Wells score with the other detection methods.Methods In this case control study,121 cases were selected from the patients who were from general and orthopeadic surgery (including thrombosis group in 60 cases and non thrombosis group in 61 cases).The patients were assessed by Wells score.From one day before surgery, Plasma d-dimer (D-D) and fibrin monomer (FM) were periodic measured by CP-2000 d-dimer and fibrin monomer.Evaluation the value of d-dimer,fibrin monomer and fibrin monomer combined with Wells score in diagnosis of venous thromboembolic disease.The receiver operation cure(ROC) was drew to determine the diagnostic performance.Results The plasma FM level of patients with VTE in the thrombus group (26.11±38.34) μg/ml is higher than the non thrombus group (6.56±6.81) μg/ml and the control group (2.37±0.89) μg/ml (t=-3.82, t=-4.78,P<0.01);the sensitivity of FM was lower than the D-D (85% vs 93%);then the positive predictive value was lower than D-D (82% vs 87%) (χ2=27.01,P=0.000)but its specificity and negative predictive value (65%) are both higher than D-D (65% vs 44%)(71% vs 62%)(χ2=11.67,P=0.001);the sensitivity,the specificity,the positive predictive value and the negative predictive value of FM combined Wells score are increased (90%,85%,83%,89%)(χ2=20.95,χ2=16.65,P<0.01).The increased level of FM is earlier than imaging changes, and the elevated of plasma D-D is not obvious in a certain period of time.Conclusions The sensitivity and specificity of FM combined with Wells′ score is higher in the diagnosis of VTE, its prediction value in the diagnosis of VTE is higher.The FM level can be changed in the early stage of VTE, which has a certain value of early diagnosis.
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Objective To investigate the drug resistance rate and homology of Pseudomonas aeruginosa isolated from ICU in Mudanjiang Municipal First People′s Hospital from January to June 2015 to understand its prevalence situation in ICU and provide a basis for the rational prevention and control of nosocomial infection.Methods The Vitek-2 Compact fully automatic microbiologi-cal identification instrument was adopted to perform the drug resistance analysis on 126 strains of Pseudomonas aeruginosa from ICU detected by different pathways in the first half of 2015.The homology of bacterial strains was analyzed by pulse-field gel elec-trophoresis(PFGE).Results Two nosocomial infection monitorings were performed in ICU from January to June 2015.Four strains of Pseudomonas aeruginosa isolated from the nurse hand,medicative cart and doorknob of ICU ward all were sensitive strains;122 strains of Pseudomonas aeruginosa were detected in 110 ICU inpatients,in which 38 multi-drug resistant strains were detected from 18 ICU inpatients.The homology analysis was performed in 38 multi-drug resistant strains and 4 strains detected by nosocomial infection monitoring,these strains included 5 groups (A-E),which was dominated by the clone types of A,B and C, while the strains detected by nosocomial infection monitoring all were clone type B.Multiple subtype infection was detected in 4 pa-tients.Conclusion The infection situation of Pseudomonas aeruginosa is serious in ICU,no epidemic outbreak of strains detected by nosocomial infection monitoring exists.The cross prevalence of multiple clone strains exists in inpatients.