School of Medicine, University of Virginia, Charlottesville, VA, USA.
J Am Acad Dermatol. 2011 Feb;64(2):405-12. doi: 10.1016/j.jaad.2009.12.007. Epub 2010 Aug 12.
The role of a hypercoagulable state in the pathogenesis of calciphylaxis has yet to be determined.
We sought to find evidence of an association between hypercoagulability and calciphylaxis.
We reviewed the primary literature for review articles, studies, and case reports that discussed or demonstrated a possible relationship between calciphylaxis and a hypercoagulable state.
Review of the primary literature showed that in cases of calciphylaxis with reported levels of protein C and S, 38% of the patients had decreased protein C levels and 43% had decreased levels of protein S. From review of case reports, 3 cases of improvement of skin lesions with low molecular weight heparin treatment, and a fourth case of healing of skin lesions with tissue plasminogen activator treatment, were found. Calciphylaxis was also found in a patient with antiphospholipid antibody syndrome, and a patient with cryofibrinogenemia had clinical and histologic findings consistent with possible calciphylaxis.
A limited number of reports were available for review.
Our review of the literature found sufficient evidence to suggest a possible role of a hypercoagulable state in the pathogenesis of calciphylaxis. A prospective study with serial testing of all relevant clotting factors in patients with calciphylaxis is needed to more definitively establish this role.
高凝状态在钙化防御发病机制中的作用尚未确定。
我们试图寻找高凝状态与钙化防御之间关联的证据。
我们查阅了有关钙化防御和高凝状态之间可能存在关联的综述文章、研究和病例报告的原始文献。
对原始文献的回顾表明，在报告蛋白 C 和 S 水平的钙化防御病例中，38%的患者蛋白 C 水平降低，43%的患者蛋白 S 水平降低。从病例报告的回顾中，发现 3 例低分子肝素治疗皮肤病变改善，以及 1 例组织型纤溶酶原激活剂治疗皮肤病变愈合的病例。抗磷脂抗体综合征患者也发现钙化防御，而冷纤维蛋白原血症患者的临床和组织学发现与可能的钙化防御一致。
可用于审查的报告数量有限。
我们对文献的回顾发现，有充分的证据表明高凝状态可能在钙化防御的发病机制中起作用。需要对钙化防御患者进行所有相关凝血因子的系列检测的前瞻性研究，以更明确地确定这一作用。
