Harris Katie, Laws Jonathan Michael, Elias Antoine, Green David Andrew, Goswami Nandu, Jordan Jens, Kamine Tovy Haber, Mazzolai Lucia, Petersen Lonnie G, Winnard Andrew James, Weber Tobias
Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
Space Biomedicine Systematic Review Methods Group, Wylam, United Kingdom.
Front Physiol. 2022 Apr 27;13:885183. doi: 10.3389/fphys.2022.885183. eCollection 2022.
The recent discovery of a venous thrombosis in the internal jugular vein of an astronaut has highlighted the need to predict the risk of venous thromboembolism in otherwise healthy individuals (VTE) in space. Virchow's triad defines the three classic risk factors for VTE: blood stasis, hypercoagulability, and endothelial disruption/dysfunction. Among these risk factors, venous endothelial disruption/dysfunction remains incompletely understood, making it difficult to accurately predict risk, set up relevant prophylactic measures and initiate timely treatment of VTE, especially in an extreme environment. A qualitative systematic review focused on endothelial disruption/dysfunction was conducted following the guidelines produced by the Space Biomedicine Systematic Review Group, which are based on Cochrane review guidelines. We aimed to assess the venous endothelial biochemical and imaging markers that may predict increased risk of VTE during spaceflight by surveying the existing knowledge base surrounding these markers in analogous populations to astronauts on the ground. Limited imaging markers related to endothelial dysfunction that were outside the bounds of routine clinical practice were identified. While multiple potential biomarkers were identified that may provide insight into the etiology of endothelial dysfunction and its link to future VTE, insufficient prospective evidence is available to formally recommend screening potential astronauts or healthy patients with any currently available novel biomarker. Our review highlights a critical knowledge gap regarding the role biomarkers of venous endothelial disruption have in predicting and identifying VTE. Future population-based prospective studies are required to link potential risk factors and biomarkers for venous endothelial dysfunction to occurrence of VTE.
最近一名宇航员颈内静脉发现静脉血栓，这凸显了预测太空环境中原本健康个体发生静脉血栓栓塞（VTE）风险的必要性。魏尔啸氏三联征定义了VTE的三个经典风险因素：血流淤滞、高凝状态和内皮损伤/功能障碍。在这些风险因素中，静脉内皮损伤/功能障碍仍未被完全理解，这使得准确预测风险、制定相关预防措施以及及时启动VTE治疗变得困难，尤其是在极端环境中。按照空间生物医学系统评价小组制定的指南（该指南基于Cochrane系统评价指南），开展了一项聚焦于内皮损伤/功能障碍的定性系统评价。我们旨在通过调查地面上与宇航员类似人群中这些标志物的现有知识库，评估可能预测太空飞行期间VTE风险增加的静脉内皮生化和成像标志物。确定了一些超出常规临床实践范围的与内皮功能障碍相关的有限成像标志物。虽然确定了多种潜在生物标志物，它们可能有助于深入了解内皮功能障碍的病因及其与未来VTE的联系，但尚无足够的前瞻性证据正式推荐对潜在宇航员或健康患者使用任何现有新型生物标志物进行筛查。我们的综述凸显了关于静脉内皮损伤生物标志物在预测和识别VTE中作用的关键知识空白。未来需要开展基于人群的前瞻性研究，以将静脉内皮功能障碍的潜在风险因素和生物标志物与VTE的发生联系起来。
