脑脊液D-二聚体评估胶质瘤脑室侵犯和脊髓播散的临床意义

doi:10.19401/j.cnki.1007-3639.2018.09.001

中国癌症杂志 ›› 2018, Vol. 28 ›› Issue (9): 641-648.doi: 10.19401/j.cnki.1007-3639.2018.09.001

脑脊液D-二聚体评估胶质瘤脑室侵犯和脊髓播散的临床意义

陈建新¹，康　勋²，李　岩¹，李　珊¹，康　庄¹，李文斌²

1. 首都医科大学附属北京世纪坛医院脑胶质瘤科，北京 100038 ；
2. 首都医科大学附属北京天坛医院神经肿瘤综合治疗科，北京 100050

出版日期:2018-09-30 发布日期:2018-10-26
通信作者: 李文斌 E-mail：15301377998@126.com

Clinical significance of cerebrospinal fluid D-dimer in glioma patients with ventricular metastasis and spinal cord metastasis

CHEN Jianxin¹, KANG Xun2, LI Yan¹, LI Shan¹, KANG Zhuang¹, LI Wenbin²

1. Department of Brain Glioma, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China; 2. Department of General Nervous Cancer Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China

Published:2018-09-30 Online:2018-10-26
Contact: LI Wenbin E-mail: 15301377998@126.com

摘要/Abstract

摘要： 背景与目的：胶质瘤是最常见的原发中枢神经系统肿瘤，该研究通过测定胶质瘤患者脑脊液和血浆D-二聚体水平，探讨脑脊液和血浆D-二聚体评估胶质瘤脑室侵犯（ventricular metasasis，VM）和脊髓播散（spinal cord metastasis，SCM）的临床意义。方法：83例胶质瘤患者根据不同临床特点分为未复发组和复发组；脑实质组、VM组和SCM组；原发脊髓播散（primary spinal cord metastasis，PSCM）组和继发脊髓播散（secondary spinal cord metastasis，SSCM）组，化疗前检测患者脑脊液和血浆D-二聚体，分析脑脊液和血浆D-二聚体水平与胶质瘤VM和SCM的关系。结果：复发组脑脊液D-二聚体显著高于未复发组（P=0.000 3），SCM组显著高于VM组（P=0.001 5），VM组和SCM组显著高于脑实质组（P=0.000 1，P=0.000 3），SSCM组显著高于PSCM组（P=0.000 5），VM组（P=0.000 1）和SCM组（P=0.005 0）治疗后减少差异有统计学意义。SCM组血浆D-二聚体显著高于VM组（P=0.023 5）和脑实质组（P=0.000 5），复发组与未复发组（P=0.371 8）、PSCM组与SSCM组（P=0.059 2）差异无统计学意义，VM组（P=0.182 4）和SCM组（P=0.093 3）治疗后减少差异也无统计学意义。受试者工作特征（receiver operating characteristic，ROC）曲线中脑脊液和血浆D-二聚体的截断值分别为69和219 ng/mL，灵敏度和特异度分别为86.75%、94.12%和34.94%、94.12%。结论：脑脊液D-二聚体可作为特异性预示胶质瘤VM或SCM和评估疗效的良好标志物。

关键词: 胶质瘤, 脑脊液, D-二聚体, 脑室侵犯, 脊髓播散

Abstract: Background and purpose: Glioma is the most common primary tumor of the central nervous system. This study aimed to investigate the clinical significance of cerebrospinal fluid (CSF) and plasma D-dimer levels and the relation with ventricular metastasis (VM) and spinal cord metastasis (SCM) of glioma. Methods: The CSF and plasma D-dimer levels were measured in 83 glioma patients. The glioma patients were divided into unrelapsed group and relapse group; parenchyma group, VM group and SCM group; primary spinal cord metastasis (PSCM) group and secondary spinal cord metastasis (SSCM) group according to the clinical characteristics. We investigated the relationship between the levels of CSF or plasma D-dimer and spinal cord metastasis or ventricular metastasis of glioma. Results: The CSF D-dimer level of relapse group was significantly higher than that of unrelapsed group (P=0.000 3). The CSF D-dimer level of SCM group was significantly higher than that of VM group (P=0.001 5). The CSF D-dimer levels of VM and SCM groups were significantly higher compared with parenchyma group (P=0.000 1, P=0.000 3). The CSF D-dimer level of SSCM group was significantly higher than that of PSCM group (P=0.000 5). The CSF D-dimer levels of VM (P=0.0001) and SCM groups (P=0.005 0) were significantly reduced after chemotherapy. The plasma D-dimer level of SCM group was significantly higher compared with VM group (P=0.023 5) and parenchyma group (P=0.000 5). There was no significant difference in the plasma D-dimer level between unrelapsed and relapse groups (P=0.371 8) or PSCM and SSCM groups (P=0.059 2). The plasma D-dimer levels of VM group (P=0.182 4) and SCM group (P=0.093 3) did not decrease significantly after chemotherapy. In the receiver operating characteristic (ROC) curve, the optimal cut-off points for CSF and plasma D-dimer levels were found to be 69 and 219 ng/mL in glioma patients with sensitivity and specificity of 86.75 %, 94.12% and 34.94%, 94.12%, respectively. Conclusion: D-dimer might be an important clinical marker for spinal cord metastasis or ventricular metastasis and response evaluation in glioma.

Key words: Glioma, Cerebrospinal fluid, D-dimer, Ventricular metastasis, Spinal cord metastasis

陈建新,康　勋,李　岩,等. 脑脊液D-二聚体评估胶质瘤脑室侵犯和脊髓播散的临床意义[J]. 中国癌症杂志, 2018, 28(9): 641-648.

CHEN Jianxin, KANG Xun, LI Yan, et al. Clinical significance of cerebrospinal fluid D-dimer in glioma patients with ventricular metastasis and spinal cord metastasis[J]. China Oncology, 2018, 28(9): 641-648.

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脑脊液D-二聚体评估胶质瘤脑室侵犯和脊髓播散的临床意义

Clinical significance of cerebrospinal fluid D-dimer in glioma patients with ventricular metastasis and spinal cord metastasis

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