Relationship Between Changes Of D-Dimer And Venous Thrombosis In Patients With Non-Small Cell Lung Cancer During Perioperative Period

Objective: To analyze the changes of D-dimer in patients with non-small cell lung cancer(NSCLC)during perioperative period and its value in predicting lower extremity venous thrombosis.Methods: A retrospective analysis of 180 patients with non-small cell lung cancer undergoing surgery in the Affiliated Hospital of Hebei University from January 2017 to October 2017..Clinical data including gender,age,TNM stage,differentiation and pathological types were collected.Perioperative D-dimer levels were measured in all patients(24 hours before operation,1 day,3 days,7 days and 10 days after operation),and summarize its change rule.Ultrasonography of lower extremity vessels was performed before and after operation.Logistic regression analysis was used to analyze the influencing factors of perioperative venous thrombosis in lower extremities.Results:1.The level of D-dimer in postoperative patients was significantly higher than that in 24 hours before operation(P<0.001).The level of D-dimer increased with the prolongation of postoperative time and reached a peak value of(3.92(3.40)mg/L on the 7th day after operation.However,the level of D-dimer in non-small cell lung cancer patients decreased on the 10 th day after operation.2.35 patients with non-small cell lung cancer(NSCLC)developed lower extremity venous thrombosis during perioperative period.The incidence rate was 19.44%.161 patients whose detection was more than 0.5mg/L 24 hours before operation were included in the positive group.The positive rate was 89.44%.The incidence of lower extremity venous thrombosis in preoperative D-dimer positive group was significantly higher than that in negative group,and the difference was statistically significant(P<0.001).The sensitivity and specificity of D-dimer were 94.29%(33/35)and 11.72%(17/145)respectively.3.Univariate analysis showed that the length of operation(?2 = 6.178,P<0.05),pathological type(?2 = 6.066,P<0.05),pathological stage(?2 = 15.607,P<0.001),differentiation degree(?2=46.42,P<0.001)were the related factors of lower extremity venous thrombosis in patients with lung cancer during perioperative period,and were related to sex,age,history of hypertension.No significant difference was found in diabetes history,smoking history and drinking history(P>0.05).The results of binary logistic regression analysis showed that the risk factors of lower extremity venous thrombosis in patients with lung cancer during perioperative period were the length of operation(>90 minutes),adenocarcinoma,pathological stage III + IV,and degree of differentiation.Conclusion: Plasma D-dimer levels in patients with non-small cell lung cancer after surgery were significantly higher than those 24 hours before surgery.Predicting lower extremity venous thrombosis with plasma D-dimer levels is highly sensitive but low specificity.It is necessary to prevent lower extremity venous thrombosis in patients with abnormal fluctuation of plasma D-dimer levels after surgery.Use of anticoagulant drugs.This study suggests that sex,age,history of hypertension,diabetes mellitus,smoking and drinking have nothing to do with the occurrence of lower extremity venous thrombosis in patients with lung cancer during the perioperative period,but the length of operation(>90 minutes),adenocarcinoma,pathological stage III + IV,and the degree of differentiation is associated with high incidence of lower extremity venous thrombosis.It is also a risk factor for lower extremity venous thrombosis in perioperative patients with lung cancer.