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目的：研究血栓标志物对恶性肿瘤患者静脉血栓栓塞（ VTE）风险的评估价值。方法选择2009—2012年就诊于天津医科大学总manbet官网登录 的恶性肿瘤患者1473例，采用ACL TOP 700型血液凝固仪测定血管性血友病因子抗原含量（ vWF：Ag）、凝血因子Ⅶ活性（ FⅦ：A）、凝血因子Ⅷ活性（ FⅧ：A）、蛋白C活性（PC：A）、蛋白S 活性（PS：A）和抗凝血酶活性（AT：A），采用法国梅里埃VIDAS荧光免疫分析仪测定血浆D-二聚体（ D-D）水平。采用受试者工作特征曲线（ROC 曲线）评价各项指标的诊断性能，对预后因素的分析采用Cox回归模型，采用Kaplan-Meier曲线进行生存分析。结果除其他未分型肿瘤外，各类型肿瘤患者中vWF：Ag、D-D和FⅦ：A水平均高于对照组（均P＜0．05）。除肾癌、前列腺癌、淋巴瘤和其他肿瘤外，各类型肿瘤患者中F Ⅷ：A水平均高于对照组（均P＜0．05）。除脑胶质瘤、乳腺癌、胃癌、肾癌和其他肿瘤外，各类型肿瘤患者中PC：A水平均低于对照组（均P＜0．05）。除脑胶质瘤、乳腺癌、前列腺癌、淋巴瘤和其他肿瘤外，各类型肿瘤患者中PS：A水平均低于对照组（均P＜0．05）。各类型肿瘤患者中AT：A水平均低于对照组（均P＜0．05）。 vWF：Ag诊断恶性肿瘤患者VTE的临界值为192％时，ROC曲线下面积为0．828（95％CI为0．716～0．939）；D-D临界值为1484 ng／ml时，ROC曲线下面积为0．915（95％CI为0．840～0．988）；PC：A临界值为75．2％时，ROC曲线下面积为0．764（95％CI为0．630～0．898）。 Cox比例风险模型显示，年龄、手术、化疗和D-D水平是恶性肿瘤患者随访3个月内发生VTE的独立风险因素。血浆D-D水平高于临界值的恶性肿瘤患者VTE累计发生概率显著增高。结论恶性肿瘤患者血浆D-D水平显著增高，并与恶性肿瘤患者的血栓风险分层和VTE风险概率密切相关，具有良好的诊断性能，可作为评价恶性肿瘤患者随访3个月内VTE风险的有效指标。

Objective To assess the value of thrombotic biomarkers in estimation of venous thromboembolism ( VTE) risk in cancer patients.Methods A total of 1473 cancer patients treated in the Tianjin Medical University General Hospital from 2009 to 201 were selected, including 845 males and 628 females in the age of 56±17 years.The activities of von Willebrand factor antigen ( vWF:Ag) , factorⅦ( FⅦ:A), factor Ⅷ (FⅧ:A), antithrombin (AT:A), protein C (PC:A) and protein S (PS:A) were assayed using an ACL TOP 700 blood coagulation analyzer.The level of D-dimer ( D-D) was assayed using the Biomerieux Mini Vidas Automated Immunoassay Analyzer.Receiver operating characteristic curve ( ROC) was used to analyze the diagnostic performance of the parameters.Cox regression analysis model was applied to evaluate the effect on prognosis, and Kaplan-Meier curve was used to implement the survival analysis.Results The levels of vWF:Ag, D-D, and FⅧ:A were significantly higher in all the specified tumor groups ( except the other tumor group ) than that of the control groups ( P<0.05 ) .FⅧ:A was significantly higher than that in the control group in all tumor groups except the renal carcinoma, prostatic cancer, lymphoma groups and the other tumor group ( P<0.05) .The PC:A level was significantly lower in all tumor patients groups than in the control group, except glioma, breast cancer, gastric carcinoma, renal carcinoma and the other tumors groups ( P<0.05) .The PS:A level was significantly lower in all tumor groups than in the control group, except the glioma, breast cancer, prostatic cancer, lymphoma and the other tumors groups (P<0.05).The AT:A level was significantly lower in all tumor groups than in the control&nbsp;group (P<0.05).When the optimum cut-off point of vWF:Ag for VTE diagnosis was 192%in the cancer group, the area under ROC curve=0.828 ( 95%CI:0.716 to 0.939) .When the optimum cut-off point of D-dimer for VTE diagnosis was 1484 ng/ml in the cancer group, the area under ROC curve=0.915 ( 95%confidence interval: 0.840 to 0.988).When the optimum cut-off point of PC:A for VTE diagnosis was 75.2%in the cancer group, the area under ROC curve=0.764 ( 95%confidence interval:0.630 to 0.898) . The Cox analysis showed that age, surgery, chemotherapy and D-dimer were independent risk factors for VTE event within three months in cancer patients.The cumulative probability of VTE was increased significantly in the cancer patients if whose plasma D-dimer level was over the cut-off value.Conclusions The plasma D-dimer level is obviously increased in cancer patients, and there is a relevance to thrombosis risk stratification and VTE cumulative probability.It is with good diagnostic performance, and may be used as an effective marker in estimation of VTE risk within 3 months in cancer patients.