Carobbio Alessandra, Finazzi Guido, Antonioli Elisabetta, Guglielmelli Paola, Vannucchi Alessandro M, Delaini Federica, Guerini Vittoria, Ruggeri Marco, Rodeghiero Francesco, Rambaldi Alessandro, Barbui Tiziano
Department of Hematology, Ospedali Riuniti di Bergamo, Bergamo, Italy.
Blood. 2008 Oct 15;112(8):3135-7. doi: 10.1182/blood-2008-04-153783. Epub 2008 Jun 27.
To elucidate the role of thrombocytosis, alone or in combination with standard (age, previous cardiovascular events) and novel (leukocytosis, JAK2(V617F) mutational status) risk factors, in the cardiovascular events of essential thrombocythemia (ET), we analyzed a cohort of 1063 patients. We found that a platelet count at diagnosis greater than 1000 x 10(9)/L was associated with significantly lower rate of thrombosis in multivariable analysis and, if combined with leukocytes less than 11 x 10(9)/L, pointed to a "low-risk" category with a rate of thrombosis of 1.59% of patients/year. On the contrary, the highest risk category (thrombosis rate, 2.95% of patients/year) was constituted of patients with leukocytosis, lower platelet count, and a JAK2(V617F) mutated genotype in most cases (77% vs 26% in the low-risk group), independently from standard risk factors. These data challenge the theory that elevated platelet count increases thrombosis risk in ET and suggest prospective clinical trials to support this hypothesis.
为阐明血小板增多单独或与标准（年龄、既往心血管事件）及新的（白细胞增多、JAK2(V617F)突变状态）危险因素联合在原发性血小板增多症（ET）心血管事件中的作用，我们分析了一个包含1063例患者的队列。我们发现，在多变量分析中，诊断时血小板计数大于1000×10⁹/L与显著更低的血栓形成率相关，并且，如果与白细胞计数低于11×10⁹/L相结合，则指向一个“低风险”类别，其血栓形成率为每年1.59%的患者。相反，最高风险类别（血栓形成率为每年2.95%的患者）在大多数情况下（77%对比低风险组的26%）由白细胞增多、血小板计数较低且具有JAK2(V617F)突变基因型的患者组成，与标准危险因素无关。这些数据对血小板计数升高会增加ET患者血栓形成风险这一理论提出了挑战，并建议进行前瞻性临床试验以支持这一假设。
