Department of Cardiologic, Thoracic and Vascular Sciences, Padua University Hospital, Via Giustiniani 2, 35128 Padova, Italy.
J Neurooncol. 2011 Aug;104(1):225-31. doi: 10.1007/s11060-010-0462-8. Epub 2010 Nov 23.
The relationship between venous thromboembolism (VTE) and cancer is supported by several pathogenetic factors, including circulating microparticles (MP) originating from different cells and often bearing tissue factor. Since VTE often complicates the clinical course of patients with glioblastoma multiforme (GBM; WHO grade IV astrocytoma) and the role of MPs in these patients population is still not clear, this prospective study was conducted to evaluate the procoagulant activity of circulating MP (MP activity) in GBM patients. We enrolled 61 GBM patients undergoing gross-total or subtotal surgical resection followed by combined radio-chemotherapy; 20 healthy volunteers were tested as controls. Blood samples for MP activity and hemostatic profiles were obtained before and then 1 week and 1, 4, and 7 months after surgery. GBM patients had significantly higher mean MP activity levels than healthy controls before and 7 days after surgery. During the follow-up, MP activity levels became significantly lower 1 and 4 months after surgery (P = 0.007 and P = 0.018, respectively) than prior to surgery, but this decrease was only seen in the subgroup achieving complete tumor resection. MP activity levels increased in 7 (63.6%) of 11 patients who developed VTE. The different incidence of the increase in MP activity levels between patients with and without VTE was statistically significant (χ (2) = 4.93, P = 0.026; relative risk 1.38, 95% CI 1.03-1.86). GBM patients may have an increase in MP-associated procoagulant activity that could contribute to any prothrombotic states and increases the likelihood of VTE complications; this procoagulant activity drops during control of disease.
静脉血栓栓塞症（VTE）与癌症之间的关系受到多种发病机制因素的支持，包括来自不同细胞的循环微粒（MP），这些 MP 通常携带组织因子。由于 VTE 常使多形性胶质母细胞瘤（GBM；IV 级星形细胞瘤）患者的临床病程复杂化，且 MPs 在这些患者群体中的作用尚不清楚，因此进行了这项前瞻性研究以评估 GBM 患者循环 MP 的促凝活性（MP 活性）。我们纳入了 61 名接受大体或次全手术切除后联合放化疗的 GBM 患者；20 名健康志愿者作为对照进行检测。在手术前、手术后 1 周以及 1、4 和 7 个月时，采集用于 MP 活性和止血谱检测的血样。与健康对照组相比，GBM 患者在手术前和手术后 7 天的平均 MP 活性水平显著升高。在随访期间，与手术前相比，手术后 1 个月和 4 个月时 MP 活性水平显著降低（P = 0.007 和 P = 0.018），但这种降低仅见于肿瘤全切亚组。11 例发生 VTE 的患者中有 7 例（63.6%）的 MP 活性水平增加。在发生 VTE 与未发生 VTE 的患者中，MP 活性水平增加的发生率存在显著差异（χ²（2）= 4.93，P = 0.026；相对风险 1.38，95%CI 1.03-1.86）。GBM 患者可能存在与 MP 相关的促凝活性增加，这可能导致任何促血栓形成状态并增加 VTE 并发症的可能性；这种促凝活性在疾病控制期间下降。
