术前血小板聚集功能与凝血指标预测老年胃肠肿瘤患者术后并发症的价值

doi:10.3877/cma.j.issn.2095-2015.2026.03.002

中华消化病与影像杂志(电子版) ›› 2026, Vol. 16 ›› Issue (03) : 199 -205. doi: 10.3877/cma.j.issn.2095-2015.2026.03.002

论著

术前血小板聚集功能与凝血指标预测老年胃肠肿瘤患者术后并发症的价值

王亚楠¹^,^†(

), 宋岩², 王胤³, 郭城⁴, 陈俊涛¹, 李锋¹, 苑小雷¹

¹236500　安徽省，界首市人民医院药剂科
²236500　安徽省，界首市人民医院医学影像科
⁴236500　安徽省，界首市人民医院消化内科
³236800　安徽省，亳州市人民医院消化内科

收稿日期:2025-12-26 出版日期:2026-06-01
通信作者: 王亚楠
基金资助:
安徽省中医药传承创新科研项目(2024CCCX242); 阜阳市卫生健康科研项目(FYHR2024-029)

Application value of preoperative platelet aggregation function combined with coagulation index monitoring in predicting postoperative complications in elderly patients with gastrointestinal tumors

Yanan Wang¹^,^†(), Yan Song², Yin Wang³, Cheng Guo⁴, Juntao Chen¹, Feng Li¹, Xiaolei Yuan¹

¹Department of Pharmacy, Jieshou People's Hospital, Jieshou 236500, China
²Department of Medical Imaging, Jieshou People's Hospital, Jieshou 236500, China
⁴Department of Gastroenterology, Jieshou People's Hospital, Jieshou 236500, China
³Department of Gastroenterology, Bozhou People's Hospital, Bozhou 236800, China

Received:2025-12-26 Published:2026-06-01
Corresponding author: Yanan Wang

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引用本文：

王亚楠, 宋岩, 王胤, 郭城, 陈俊涛, 李锋, 苑小雷. 术前血小板聚集功能与凝血指标预测老年胃肠肿瘤患者术后并发症的价值[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(03): 199-205.

Yanan Wang, Yan Song, Yin Wang, Cheng Guo, Juntao Chen, Feng Li, Xiaolei Yuan. Application value of preoperative platelet aggregation function combined with coagulation index monitoring in predicting postoperative complications in elderly patients with gastrointestinal tumors[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2026, 16(03): 199-205.

目的

探讨术前联合监测血小板聚集功能与凝血指标对老年胃肠肿瘤患者术后并发症的预测价值。

方法

回顾性选取界首市人民医院和亳州市人民医院2021年1月至2024年5月行胃肠肿瘤根治性手术的老年胃肠肿瘤患者252例。收集所有患者术前1 d的血小板聚集功能[二磷酸腺苷诱导的最大血小板聚集率（ADP-MAR）、花生四烯酸诱导的最大血小板聚集率（AA-MAR）]及凝血指标[凝血酶原时间（PT）、D-二聚体（D-D）、纤维蛋白原（FIB）、活化部分凝血活酶时间（APTT）]。记录术后30 d内并发症发生情况，将患者分为并发症组（74例）和无并发症组（178例），分析两组临床资料及影响并发症发生的因素并评估影响因素预测效能。

结果

术后总体并发症发生率为29.36%（74/252），并发症组与无并发症组在年龄、美国麻醉医师协会（ASA）分级、TNM分期、术式、ADP-MAR、AA-MAR、PT、APTT、FIB、D-D方面存在显著差异（P<0.05）。Spearman相关性分析显示，术前血小板聚集功能指标、凝血指标与并发症发生呈显著正相关（P<0.05）。多因素Logistic回归模型分析显示，年龄、ADP-MAR、AA-MAR、FIB、D-D水平、ASA分级是影响老年胃肠肿瘤患者术后并发症发生的危险因素（P<0.05）。ROC曲线分析显示，列线图模型预测总体并发症的AUC为0.906（95% CI 0.860~0.953）；预测血栓相关并发症的AUC为0.923（95% CI 0.881~0.965），预测非血栓相关并发症的AUC为0.878（95% CI 0.821~0.935）。

结论

术前联合监测血小板聚集功能与凝血指标，结合年龄、ASA分级等临床特征，可有效识别老年胃肠肿瘤患者术后并发症高风险人群。该联合监测模式可为临床制定个体化围手术期管理方案提供循证依据，进而降低术后并发症发生率，改善患者预后。

关键词: 胃肠肿瘤, 血小板聚集功能, 凝血指标, 术后并发症, 预测

Objective

To explore the value of preoperative combined monitoring of platelet aggregation function and coagulation indexes in predicting postoperative complications in elderly patients with gastrointestinal tumors.

Methods

A retrospective selection was made of 252 elderly patients with gastrointestinal tumors who were scheduled to undergo radical surgery for gastrointestinal tumors in Jieshou People's Hospital and Bozhou People's Hospital from January 2021 to May 2024. The platelet aggregation function [maximum platelet aggregation rate induced by adenosine diphosphate (ADP-MAR), maximum platelet aggregation rate induced by arachidonic acid (AA-MAR)] and coagulation indicators [prothrombin time (PT), D-dimer (D-D), fibrinogen (FIB), activated partial thromboplastin time (APTT)] of all patients 1 day before the operation were collected. The occurrence of complications within 30 days after the operation was recorded, and the patients were divided into the complication group (74 cases) and the non-complication group (178 cases). The clinical data of the two groups and the factors influencing the occurrence of complications were analyzed, and the predictive efficacy of the influencing factors was evaluated.

Results

The overall incidence of postoperative complications was 29.36% (74/252). There were significant differences between the complication group and the non-complication group in terms of age, ASA classification, TNM stage, surgical method, ADP-MAR, AA-MAR, PT, APTT, FIB, and D-D (P<0.05). Spearman correlation analysis showed that preoperative platelet aggregation function indicators and coagulation indicators were significantly positively correlated with the occurrence of complications (P<0.05). Multivariate Logistic regression model analysis showed that age, ADP-MAR, AA-MAR, FIB, D-D levels, and ASA classification were risk factors affecting the occurrence of postoperative complications in elderly patients with gastrointestinal tumors (P<0.05). ROC curve analysis showed that the AUC of the nomogram model for predicting overall complications was 0.906 (95% CI: 0.860-0.953). The AUC for predicting thrombosis-related complications was 0.923 (95% CI: 0.881-0.965), and the AUC for predicting non-thrombosis-related complications was 0.878 (95% CI: 0.821-0.935).

Conclusion

Preoperative combined monitoring of platelet aggregation function and coagulation indexes, combined with clinical characteristics such as age and ASA classification, can effectively identify patients at high risk of postoperative complications in elderly patients with gastrointestinal tumors. This combined monitoring mode can provide evidence-based basis for clinical development of individualized perioperative management plan, thereby reducing the incidence of postoperative complications and improving the prognosis of patients.

Key words: Gastrointestinal tumors, Platelet aggregation function, Coagulation indicators, Postoperative complications, Prediction

表1 2组老年胃肠肿瘤患者临床资料比较

指标	并发症组(n=74)	无并发症组(n=178)	χ²/t	P
年龄(岁)	71.66±5.51	68.41±5.10	4.352	<0.001
男性[例(%)]	45(60.81)	102(57.30)	0.265	0.607
体重指数(kg/m²,±s)	23.05±2.76	23.57±3.02	-1.271	0.205
美国麻醉医师协会分级[例(%)]			9.741	0.002
Ⅰ~Ⅱ级	43(58.11)	138(77.53)
Ⅲ级	31(41.89)	40(22.47)
肿瘤部位[例(%)]			0.425	0.809
胃癌	28(37.84)	60(33.71)
结肠癌	25(33.78)	66(37.08)
直肠癌	21(28.38)	52(29.21)
TNM分期[例(%)]			7.799	0.005
Ⅰ~Ⅱ期	24(32.43)	92(51.69)
Ⅲ期	50(67.57)	86(48.31)
高血压[例(%)]	25(33.78)	50(28.09)	0.811	0.368
糖尿病[例(%)]	8(10.81)	12(6.74)	1.185	0.276
心血管疾病[例(%)]	15(20.27)	24(13.48)	1.841	0.175
新辅助治疗[例(%)]
是	17(22.97)	48(26.97)	0.435	0.509
否	57(77.03)	130(73.03)
术式[例(%)]			5.496	0.019
腹腔镜手术	30(40.54)	101(56.74)
开腹手术	44(59.46)	77(43.26)

表1 2组老年胃肠肿瘤患者临床资料比较

指标	并发症组(n=74)	无并发症组(n=178)	χ²/t	P
年龄(岁)	71.66±5.51	68.41±5.10	4.352	<0.001
男性[例(%)]	45(60.81)	102(57.30)	0.265	0.607
体重指数(kg/m²,±s)	23.05±2.76	23.57±3.02	-1.271	0.205
美国麻醉医师协会分级[例(%)]			9.741	0.002
Ⅰ~Ⅱ级	43(58.11)	138(77.53)
Ⅲ级	31(41.89)	40(22.47)
肿瘤部位[例(%)]			0.425	0.809
胃癌	28(37.84)	60(33.71)
结肠癌	25(33.78)	66(37.08)
直肠癌	21(28.38)	52(29.21)
TNM分期[例(%)]			7.799	0.005
Ⅰ~Ⅱ期	24(32.43)	92(51.69)
Ⅲ期	50(67.57)	86(48.31)
高血压[例(%)]	25(33.78)	50(28.09)	0.811	0.368
糖尿病[例(%)]	8(10.81)	12(6.74)	1.185	0.276
心血管疾病[例(%)]	15(20.27)	24(13.48)	1.841	0.175
新辅助治疗[例(%)]
是	17(22.97)	48(26.97)	0.435	0.509
否	57(77.03)	130(73.03)
术式[例(%)]			5.496	0.019
腹腔镜手术	30(40.54)	101(56.74)
开腹手术	44(59.46)	77(43.26)

表2 2组老年胃肠肿瘤患者术前血小板聚集功能与凝血指标比较（

±s）

指标	并发症组(n=74)	无并发症组(n=178)	t	P
ADP-MAR(%)	61.60±8.08	53.79±7.60	7.103	<0.001
AA-MAR(%)	54.27±7.70	48.62±6.33	5.573	<0.001
PT(s)	12.77±2.08	12.22±1.41	2.063	0.042
APTT(s)	33.80±5.53	32.33±4.19	2.052	0.043
FIB(g/L)	4.05±1.26	3.23±0.79	5.150	<0.001
D-D(μg/mL)	0.95±0.20	0.87±0.17	3.079	0.003

表2 2组老年胃肠肿瘤患者术前血小板聚集功能与凝血指标比较（

±s）

指标	并发症组(n=74)	无并发症组(n=178)	t	P
ADP-MAR(%)	61.60±8.08	53.79±7.60	7.103	<0.001
AA-MAR(%)	54.27±7.70	48.62±6.33	5.573	<0.001
PT(s)	12.77±2.08	12.22±1.41	2.063	0.042
APTT(s)	33.80±5.53	32.33±4.19	2.052	0.043
FIB(g/L)	4.05±1.26	3.23±0.79	5.150	<0.001
D-D(μg/mL)	0.95±0.20	0.87±0.17	3.079	0.003

表3 术前血小板聚集功能指标、凝血指标与老年胃肠肿瘤患者术后并发症的相关性

指标	统计值	ADP-MAR	AA-MAR	PT	APTT	FIB	D-D
并发症发生	r	0.373	0.340	0.194	0.165	0.345	0.192
	P	<0.001	<0.001	0.002	0.009	<0.001	0.002
血栓相关并发症	r	0.426	0.223	0.145	0.138	0.398	0.452
	P	<0.001	<0.001	0.031	0.042	<0.001	<0.001
非血栓相关并发症	r	0.278	0.305	0.168	0.157	0.263	0.176
	P	<0.001	<0.001	0.012	0.018	0.002	0.009

表3 术前血小板聚集功能指标、凝血指标与老年胃肠肿瘤患者术后并发症的相关性

指标	统计值	ADP-MAR	AA-MAR	PT	APTT	FIB	D-D
并发症发生	r	0.373	0.340	0.194	0.165	0.345	0.192
	P	<0.001	<0.001	0.002	0.009	<0.001	0.002
血栓相关并发症	r	0.426	0.223	0.145	0.138	0.398	0.452
	P	<0.001	<0.001	0.031	0.042	<0.001	<0.001
非血栓相关并发症	r	0.278	0.305	0.168	0.157	0.263	0.176
	P	<0.001	<0.001	0.012	0.018	0.002	0.009

表4 影响老年胃肠肿瘤患者术后发生并发症的多因素分析

项目	B	S.E.	Wald	P	OR(95% CI)
年龄(岁)	0.151	0.042	13.086	<0.001	1.163(1.072~1.262)
ADP-MAR(%)	0.150	0.030	25.751	<0.001	1.162(1.096~1.231)
AA-MAR(%)	0.138	0.033	17.812	<0.001	1.148(1.077~1.224)
PT(s)	.0199	0.123	2.617	0.106	1.220(0.959~1.554)
APTT(s)	0.077	0.045	2.866	0.090	1.080(0.988~1.180)
FIB(g/L)	0.927	0.226	16.896	<0.001	2.527(1.624~3.932)
D-D(μg/mL)	2.864	1.098	6.800	0.009	17.535(2.037~150.948)
ASA分级(Ⅲ级)	1.013	0.463	4.786	0.029	2.755(1.111~6.828)
TNM分期(Ⅲ期)	0.519	0.419	1.534	0.215	1.680(0.739~3.818)
术式(腹腔镜手术)	-0.779	0.432	3.254	0.071	0.459(0.197~1.070)

表4 影响老年胃肠肿瘤患者术后发生并发症的多因素分析

项目	B	S.E.	Wald	P	OR(95% CI)
年龄(岁)	0.151	0.042	13.086	<0.001	1.163(1.072~1.262)
ADP-MAR(%)	0.150	0.030	25.751	<0.001	1.162(1.096~1.231)
AA-MAR(%)	0.138	0.033	17.812	<0.001	1.148(1.077~1.224)
PT(s)	.0199	0.123	2.617	0.106	1.220(0.959~1.554)
APTT(s)	0.077	0.045	2.866	0.090	1.080(0.988~1.180)
FIB(g/L)	0.927	0.226	16.896	<0.001	2.527(1.624~3.932)
D-D(μg/mL)	2.864	1.098	6.800	0.009	17.535(2.037~150.948)
ASA分级(Ⅲ级)	1.013	0.463	4.786	0.029	2.755(1.111~6.828)
TNM分期(Ⅲ期)	0.519	0.419	1.534	0.215	1.680(0.739~3.818)
术式(腹腔镜手术)	-0.779	0.432	3.254	0.071	0.459(0.197~1.070)

图1 术后并发症发生的列线图模型注：ADP-MAR二磷酸腺苷诱导的血小板最大聚集率；AA-MAR花生四烯酸诱导的血小板最大聚集率；FIB纤维蛋白原；D-D D-二聚体；ASA美国麻醉医师协会

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Application value of preoperative platelet aggregation function combined with coagulation index monitoring in predicting postoperative complications in elderly patients with gastrointestinal tumors

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Application value of preoperative platelet aggregation function combined with coagulation index monitoring in predicting postoperative complications in elderly patients with gastrointestinal tumors