Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
Ematologia, Istituto Regina Elena, Rome, Italy.
Int J Hematol. 2009 Nov;90(4):486-491. doi: 10.1007/s12185-009-0401-7. Epub 2009 Aug 22.
We prospectively tested, at diagnosis in essential thrombocythemia (ET) patients with no clear indication to platelet (PLT)-lowering treatment, a scoring system based on age, PLT level, cardiovascular diseases, previous thrombotic events, smoking and dysmetabolic diseases. From 04/92 to 03/98, 168 consecutive patients were enrolled. Hydroxyurea (HU) was started at diagnosis in 32 "symptomatic" patients and in 33 patients aged >70 years. The remaining 103 patients ("asymptomatic" and aged <70 years) were classified according to our scoring system. Thirty-two patients with score > or = 4 started HU early after diagnosis. The remaining 71 patients with score <4 at diagnosis received anti-aggregating agents only; of them, 24 (33.8%) started HU during follow-up after a median time from diagnosis of 28 months, while 47 (66.2%) did not start any PLT-lowering treatment. Thrombotic complications occurred in 9/103 patients (8.7%); in particular, they occurred in 4/32 patients (12.5%) with score > or = 4 receiving HU since diagnosis and in 5/71 (7%) with score <4 under anti-aggregating agents only. This scoring system appears effective to discriminate a different risk of thrombotic events, and could be useful to decide when a PLT-lowering therapy needs to be started.
我们前瞻性地在没有明确血小板（PLT）降低治疗指征的原发性血小板增多症（ET）患者中进行了测试，该测试基于年龄、PLT 水平、心血管疾病、既往血栓事件、吸烟和代谢紊乱疾病建立了一个评分系统。从 1992 年 4 月至 1998 年 3 月，共纳入了 168 例连续患者。在 32 名“有症状”患者和 33 名年龄>70 岁的患者中，诊断时即开始使用羟基脲（HU）。其余 103 名“无症状”且年龄<70 岁的患者根据我们的评分系统进行分类。32 名评分>或=4 的患者在诊断后不久即开始 HU。其余 71 名诊断时评分<4 的患者仅接受抗血小板药物；其中，24 名（33.8%）在中位时间为 28 个月的诊断后开始 HU，而 47 名（66.2%）未开始任何 PLT 降低治疗。103 例患者中有 9 例（8.7%）发生血栓并发症；特别是，在诊断后开始 HU 的评分>或=4 的 32 例患者中发生了 4 例（12.5%），而在仅接受抗血小板药物的评分<4 的 71 例患者中发生了 5 例（7%）。该评分系统似乎能有效区分不同的血栓事件风险，可能有助于决定何时需要开始 PLT 降低治疗。
