Sawaguchi K, Yabushita H, Higuchi K, Noguchi M, Ishihara M, Aoyama T, Menjoh H, Oguri T
Nihon Gan Chiryo Gakkai Shi. 1989 Apr 20;24(4):798-808.
In 12 patients (38 courses) with gynecological malignancies who had been treated with remission induction chemotherapy, we measured the levels of ESR, Platelet, PT, APTT, Hepa T, AT III, alpha 2 PI, FDP and D-dimer, and we also measured such molecular markers as Fibrinopeptide A (FPA), Fibrinopeptide B beta 1-42 (FPB beta 1-42), and Fibrinopeptide B beta 15-42 (FPB beta 15-42) before and after chemotherapy. Then the relation between the post chemotherapeutic trends and prognosis for patient with gynecological malignancies were investigated. 1) Before chemotherapy, the levels of ESR, FDP, D-dimer and FPB beta 1-42 were increased, PT and APTT were shortened significantly in cases on groups IIIrd and IVth stage compared with in cases on groups Ist and IInd stage (p less than 0.05). The levels of FPA were also high, but there was no significant differences. The levels of FPB beta 15-42 were almost same in both groups. However, the each markers indicated the existence of chronic DIC in cases of group IIIrd and IVth stage. 2) One week after chemotherapy, the levels of ESR, fibrinogen, FDP and FPA were decreased, while FPB beta 1-42 and FPB beta 15-42 were increased, suggesting elevated fibrinolytic activity. Two weeks after chemotherapy, there was stronger tendency to coagulation dominant again, but it was only temporary. Three weeks after chemotherapy, the hemostatic balance was regained. 3) In patient with complete remission after effective chemotherapy, their coagulability data were showed within normal range, however, some cases with poor prognosis were not able to obtain the recovery of hemostatic balance, and the levels of molecular markers were significantly elevated. Coagulative activity was more enhanced than fibrinolytic activity in patients with progressive gynecological malignancies, but hemostatic balance was maintained clinically. The hemostatic balance was disrupted by the chemotherapy, but this balance was regained for the IIIrd week. Accordingly, the recovery of hemostatic balance with effective chemotherapy is related to the prognosis for patients with gynecological malignancies, and the levels of molecular markers may be able to expect the prognosis for patients.
对12例接受缓解诱导化疗的妇科恶性肿瘤患者（共38个疗程），我们检测了其血沉（ESR）、血小板、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、肝转氨酶（Hepa T）、抗凝血酶III（AT III）、α2纤溶酶抑制物（α2 PI）、纤维蛋白降解产物（FDP）和D - 二聚体水平，并且在化疗前后还检测了纤维蛋白肽A（FPA）、纤维蛋白肽Bβ1 - 42（FPBβ1 - 42）和纤维蛋白肽Bβ15 - 42（FPBβ15 - 42）等分子标志物。然后研究了化疗后趋势与妇科恶性肿瘤患者预后之间的关系。1）化疗前，与I期和II期患者相比，III期和IV期患者的ESR、FDP、D - 二聚体和FPBβ1 - 42水平升高，PT和APTT显著缩短（p < 0.05）。FPA水平也较高，但无显著差异。两组的FPBβ15 - 42水平几乎相同。然而，各标志物表明III期和IV期患者存在慢性弥漫性血管内凝血（DIC）。2）化疗一周后，ESR、纤维蛋白原、FDP和FPA水平降低，而FPBβ1 - 42和FPBβ15 - 42升高，提示纤溶活性增强。化疗两周后，再次出现更强烈的凝血占优势趋势，但只是暂时的。化疗三周后，止血平衡恢复。3）有效化疗后完全缓解的患者，其凝血数据显示在正常范围内，然而，一些预后较差的病例未能恢复止血平衡，分子标志物水平显著升高。进展期妇科恶性肿瘤患者的凝血活性比纤溶活性增强更明显，但临床上止血平衡得以维持。化疗破坏了止血平衡，但在第三周恢复了这种平衡。因此，有效化疗后止血平衡的恢复与妇科恶性肿瘤患者的预后相关，分子标志物水平可能有助于预测患者的预后。
