Kedzia Malgorzata, Osinski Maciej, Mantaj Urszula, Wender-Ozegowska Ewa
Division of Reproduction, Poznan University of Medical Sciences, Poland.
Ginekol Pol. 2023;94(4):291-297. doi: 10.5603/GP.a2021.0153. Epub 2021 Sep 20.
Potential thrombotic and antifibrinolytic influence of endometriosis on haemostasis has been recently reported in the literature, as well as increased cardiovascular morbidity in women suffering from the disease. We performed a pilot study to assess the influence of endometriosis on the thrombus formation process under in vitro flow conditions.
This study compared women with confirmed endometriosis (n = 23) surgically and control healthy subjects (n = 10). In both groups, the same exclusion criteria were used: a prior episode of thrombosis diagnosed as acquired or inherited thrombophilia, neoplasm, and an uncertain family history of thrombosis. We evaluated the whole blood thrombogenicity using T-TAS® at a shear rate of 240 s-1 (Total-Thrombus Analysis System, Zacros, Japan).
The blood clot formation initiation time (T10) and occlusion time (OT) were significantly shortened in the endometriosis group (p < 0.05). The area under the curve (AUC30) of blood clot time formation values (BCTF) was substantially higher in the patients suffering from a disease (p = 0.03). An increase in AUC (TTAS) values by 100 increases the risk of developing endometriosis by 1.56-fold [adjusted OR = 1.56 (p = 0.01); (95% CI: 1.10-2.18)]. Inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), and the leucocyte, neutrophil, basophil, and neutrophil concentrations) were also substantially higher in the endometriosis group (p < 0.05).
The alteration of the T-TAS® and NLR values supports the thesis of a shift of the equilibrium towards thrombosis in women who have endometriosis. This phenomenon links to a state of chronic inflammation. It is detectable using a novel system for the quantitative assessment of the platelet thrombus formation process under flow conditions in vitro.
子宫内膜异位症对止血的潜在血栓形成和抗纤溶影响最近在文献中有所报道，该疾病女性的心血管发病率也有所增加。我们进行了一项初步研究，以评估子宫内膜异位症在体外流动条件下对血栓形成过程的影响。
本研究比较了经手术确诊为子宫内膜异位症的女性（n = 23）和健康对照者（n = 10）。两组均采用相同的排除标准：既往有诊断为获得性或遗传性血栓形成倾向、肿瘤以及血栓家族史不明的血栓形成发作。我们使用T-TAS®在240 s-1的剪切速率下评估全血血栓形成性（全血栓分析系统，日本Zacros公司）。
子宫内膜异位症组的血凝块形成起始时间（T10）和闭塞时间（OT）显著缩短（p < 0.05）。疾病患者的血凝块时间形成值（BCTF）的曲线下面积（AUC30）显著更高（p = 0.03）。AUC（TTAS）值每增加100，患子宫内膜异位症的风险增加1.56倍[调整后的OR = 1.56（p = 0.01）；（95% CI：1.10 - 2.18）]。子宫内膜异位症组的炎症标志物（中性粒细胞与淋巴细胞比值（NLR）以及白细胞、中性粒细胞、嗜碱性粒细胞和淋巴细胞浓度）也显著更高（p < 0.05）。
T-TAS®和NLR值的改变支持了子宫内膜异位症女性体内平衡向血栓形成方向转变的论点。这种现象与慢性炎症状态有关。使用一种新型系统可在体外流动条件下定量评估血小板血栓形成过程，从而检测到这种现象。
