Born P, Lippl F, Ulm K, Gerein P, Lersch C, Eckel F, Fischer G, Sandschin W, Dlaska U, Classen M
Medical Clinic II, Rechts der Isar Hospital, Germany.
Hepatogastroenterology. 2000 Jan-Feb;47(31):194-8.
BACKGROUND/AIMS: Coagulation factor XIII, which induces the stabilization of fibrin the final step in the coagulation cascade, has various physiological effects. Among these, its beneficial effect in gastrointestinal bleeding episodes is well known. With the exception of inflammatory bowel disease, however, few data are available about this effect, particularly with regard to its role in diffuse bleeding in tumor patients. The study was designed to carry out prospective follow-up investigations, gathering data concerning factor XIII levels in patients with advanced gastrointestinal tumors and evaluating the course of the disease as well as the incidence of bleeding.
Sixty patients (22 women, 38 men; median age: 60; range: 29-79) with advanced gastrointestinal tumors were followed-up prospectively. Factor XIII levels were measured using chromogenic substrate. The correlation between the FXIII level and the patients' survival was analyzed using the Cox model.
Factor XIII deficiency (below 70%) was seen in only 7 patients (11.6%), 6 of whom died within a median of 1.5 months after the measurement. In all patients however, there was a significant correlation (P = 0.0133) between FXIII levels and the risk of death. Four bleeding episodes occurred in 3 patients, three times with FXIII levels being below the lower normal range. When substitution was attempted, it was only successful in 1 patient in whom the FXIII level was reduced.
FXIII may have predictive value as a marker for the prognosis in these patients with advanced tumor disease. Bleeding episodes were rarely seen, but when they do occur they may be associated with reduced levels of FXIII, and substitution may be beneficial as an adjunct or even as the sole therapeutic intervention.
背景/目的：凝血因子 XIII 可促使纤维蛋白稳定，这是凝血级联反应的最后一步，它具有多种生理作用。其中，其在胃肠道出血发作中的有益作用是众所周知的。然而，除了炎症性肠病外，关于这种作用的数据很少，特别是关于其在肿瘤患者弥漫性出血中的作用。本研究旨在进行前瞻性随访调查，收集晚期胃肠道肿瘤患者凝血因子 XIII 水平的数据，并评估疾病进程以及出血发生率。
对 60 例晚期胃肠道肿瘤患者（22 名女性，38 名男性；中位年龄：60 岁；范围：29 - 79 岁）进行前瞻性随访。使用发色底物测定凝血因子 XIII 水平。采用 Cox 模型分析 FXIII 水平与患者生存率之间的相关性。
仅 7 例患者（11.6%）出现凝血因子 XIII 缺乏（低于 70%），其中 6 例在测量后中位 1.5 个月内死亡。然而，在所有患者中，FXIII 水平与死亡风险之间存在显著相关性（P = 0.0133）。3 例患者发生了 4 次出血事件，其中 3 次 FXIII 水平低于正常范围下限。尝试进行替代治疗时，仅 1 例 FXIII 水平降低的患者治疗成功。
FXIII 可能作为这些晚期肿瘤疾病患者预后的预测标志物具有一定价值。出血事件很少见，但一旦发生可能与 FXIII 水平降低有关，替代治疗作为辅助甚至唯一的治疗干预可能有益。
