Dasanu Constantin A, Clark Bernard A, Ichim Thomas E, Alexandrescu Doru T
Saint Francis Hospital and Medical Center, Hartford, CT, USA.
South Med J. 2011 Mar;104(3):174-8. doi: 10.1097/SMJ.0b013e31820c0172.
Subjects with polycystic ovary syndrome (PCOS) were shown to carry an increased long-term cardiovascular risk. Systemic inflammation and reactive leukocytosis have also been described in PCOS. Recent research suggests the presence of an increased thrombotic risk in these patients.
We describe a cohort of PCOS patients presenting with persistent thrombocytosis. Our cohort included women aged 20-37 who also had moderate leukocytosis and neutrophilia. They showed normal mean platelet volume and platelet aggregation. We excluded any myeloproliferative conditions in all patients.
The mean platelet count and standard deviation (SD) at presentation were 587 ± 61 × 10/L (normal 140-440 × 10/L). Median C-reactive protein (CRP) was 1.66 (range 1.2-2.2, normal <1 mg/dL). The platelet counts did not correlate with the CRP levels in our patients (Pearson correlation coefficient 0.171 and 0.170, respectively, P = 0.08).
While the inflammatory state of PCOS could play a role in triggering an increased platelet count, the persistent thrombocytosis in our patients did not correlate with the CRP levels. Therefore, from an etiological perspective, thrombocytosis appears to be at least partially independent from the classical pathways of systemic inflammation. The preexisting procoagulant state in PCOS due to coagulation cascade stimulation, platelet activation, and endothelial dysfunction may be further fueled by the presence of persistent thrombocytosis. We propose a unique model for cardiovascular risk assessment in women with PCOS to include not only the classic cardiovascular risk factors, but also the parameters related to the proinflammatory and procoagulant tendencies manifested in PCOS.
多囊卵巢综合征（PCOS）患者长期心血管疾病风险增加。PCOS患者还存在全身炎症反应和反应性白细胞增多。近期研究表明这些患者的血栓形成风险增加。
我们描述了一组患有持续性血小板增多症的PCOS患者。我们的队列包括年龄在20 - 37岁之间、同时伴有中度白细胞增多和中性粒细胞增多的女性。她们的平均血小板体积和血小板聚集功能正常。我们排除了所有患者的任何骨髓增殖性疾病。
就诊时的平均血小板计数和标准差（SD）为587±61×10⁹/L（正常范围140 - 440×10⁹/L）。C反应蛋白（CRP）中位数为1.66（范围1.2 - 2.2，正常<1mg/dL）。在我们的患者中，血小板计数与CRP水平不相关（Pearson相关系数分别为0.171和0.170，P = 0.08）。
虽然PCOS的炎症状态可能在引发血小板计数增加中起作用，但我们患者的持续性血小板增多症与CRP水平不相关。因此，从病因学角度来看，血小板增多症似乎至少部分独立于全身炎症的经典途径。PCOS中由于凝血级联刺激、血小板活化和内皮功能障碍导致的促凝状态，可能因持续性血小板增多症的存在而进一步加剧。我们提出了一个针对PCOS女性心血管风险评估的独特模型，不仅要纳入经典的心血管危险因素，还要纳入与PCOS中表现出的促炎和促凝倾向相关的参数。
