악성종양환자의 혈액응고양상에 관한 연구

Abstract

A study of hemostatic abnormalities in 102 randomly selected cancer patients was undertaken t() evaluate the overall incidence and types of bemostatic derangements in these patients by 15 coagulation tests. The results are as follows: L Majority of the patients showed one or more abnormal coagulation tests and two thirds had four or more abnormal results. Most common abnormalities were hyperfibrinogenemia (62%) and prolonged serial thromhin time (61%) followed by elevated factor VIII (45%) and VII (38%) , elevated FDP (36%) and decreased antithrombin III (28%) levels in decreasing order of frequency. 2. Patients with distant metastases (53%) more frequently had elevated FDP level compared to those without distant metastases (8%). Patients with elevated FDP level showed much higher frequency of prolonged prothrombin time, positive protamine sulfate test and decreased antithrombin III level compared to those with normal FDP level. Majority of the patients with increased FDP level showed laboratory features of compensated or overcompensated intravascular coagulation and fibrinolysis. 3. Patients with hepatoma revealed marked abnormalities in coagulation tests, and compared to patients with other types of cancer these patients showed significantly high frequency of prolonged prothrombin time as well as decreased factor II, elevated FDP, prolonged thrombin time, thrombocytopenia and decreased antithrombin III in addition to markedly increased factor VIII level; these abnormaIities were considered to be manifestations of underlying liver cirrhosis. Hepatoma patients without underlying liver cirrhosis showed normal or elevated platelet count, fibrinogen and factor VII, whereas these were markedly decreased in two thirds of the control patients with liver cirrhosis. 4. Patients with stomach cancer had significantly shortened prothrombin time and activated partial thromboplastin time compared to normal controls. and these findings along with markedly elevated fibrinogen, factor VII and VIII suggested hypercoagulability of blood. However about 30% of the patients had abnormally shortened euglobulin lysis time, representing features of increased fibrinolysis.