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癌症中血液凝固与血液流变学的相互关系。

Interrelation of blood coagulation and hemorheology in cancer.

作者信息

Tikhomirova Irina, Petrochenko Elena, Malysheva Yulia, Ryabov Mihail, Kislov Nikolay

机构信息

Department of Medicine and Biology, Yaroslavl State Pedagogical University, Yaroslavl, Russia.

Yaroslavl Regional Cancer Hospital, Yaroslavl, Russia.

出版信息

Clin Hemorheol Microcirc. 2016;64(4):635-644. doi: 10.3233/CH-168037.

Abstract

Cancer progression is associated with activation of blood coagulation. Blood coagulation process, platelet hemostasis and hemorheological properties were evaluated in patients with solid tumors (n = 27) before and after surgery and in healthy control (n = 20). The main features of blood coagulation process in cancer patients were elevated intensity and shortened period of contact phase of coagulation and inhibited fibrinolysis stage. Such prothrombotic state was fixed before surgery as well as in early postoperative period in spite of preventing thromboprophylactic treatment. Platelets depletion within the high level of spontaneous and ADP-induced platelet aggregation was fixed in cancer. The main cause of blood viscosity decrease in cancer patients was dramatic fall of Hct, because blood viscosity adjusted by Hct 40% was increased owing to the rise of plasma viscosity and substantially worsened RBC microrheological properties. The results of our study indicated close correlation between hemorheological and hemostasis parameters; these interrelations were more numerous and strong in cancer. In cancer patients the combination of a high aggregation activity of platelets, reduced number of erythrocytes (Hct), an increase of RBC aggregation and plasma viscosity caused impairment of blood oxygen transportation efficacy that provoke hypoxia in the microcirculation favoring thrombosis, settlement of tumor and metastasis.

摘要

癌症进展与血液凝固的激活有关。对27例实体瘤患者手术前后以及20例健康对照者的血液凝固过程、血小板止血和血液流变学特性进行了评估。癌症患者血液凝固过程的主要特征是凝血接触期强度升高、时间缩短以及纤维蛋白溶解阶段受到抑制。尽管进行了预防性血栓治疗,但这种血栓前状态在手术前以及术后早期均存在。在癌症患者中,高水平的自发性和ADP诱导的血小板聚集状态下存在血小板消耗。癌症患者血液粘度降低的主要原因是血细胞比容显著下降,因为经40%血细胞比容调整后的血液粘度因血浆粘度升高而增加,并且红细胞微观流变学特性明显恶化。我们的研究结果表明血液流变学和止血参数之间密切相关;这些相互关系在癌症患者中更为多样和强烈。在癌症患者中,血小板高聚集活性、红细胞数量减少(血细胞比容)、红细胞聚集增加和血浆粘度增加共同导致血液氧运输效率受损,进而引发微循环缺氧,有利于血栓形成、肿瘤定植和转移。

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