Setiawan Budi, Budianto Widi, Sukarnowati Tri Wahyu, Rizky Daniel, Pangarsa Eko Adhi, Santosa Damai, Setiabudy Rahajuningsih Dharma, Suharti Catharina
Hematology-Medical Oncology Division, Internal Medicine Department, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia.
Clinical Pathology Department, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
Int J Gen Med. 2022 Jul 19;15:6215-6226. doi: 10.2147/IJGM.S372038. eCollection 2022.
Deep vein thrombosis (DVT) is a common complication and the second leading cause of death in cancer patients. Pro-inflammatory stimuli in the cancer microenvironment induce nuclear factor kappa B (NF-κB) signaling pathway that plays an integral role in immunothrombosis mechanism.
To investigate the role of inflammatory and coagulation biomarkers in the development of DVT in cancer patients with high risk of thrombosis (Khorana score ≥2).
This study was a cross-sectional study at Dr. Kariadi General Hospital. The serum levels of proinflammatory cytokines, ie, NF-κB, interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and coagulation biomarkers, ie, tissue factor (TF), prothrombin fragment F1+2 (F1+2), fibrinogen and D-dimer were measured in newlydiagnosed cancer patients with a highrisk of thrombosis. Color duplex sonography was used for DVT screening.
From January to November 2021, there were 83 eligible patients. DVT was confirmed in 8 subjects (9.63%). Univariate analysis revealed a significant difference between the median age of patients with DVT compared to non-DVT patients, 49.5 years (range: 23-60 years) and 42 years (range: 19-60 years), with p=0.046. D-dimer level was higher in DVT patients [(6.020 µg/L, range 2.090-20.000) vs (1.940 µg/L, range 270-20.000), p=0.005]. Multivariate analysis revealed age and D-dimer were significantly correlated with DVT incidence. In all patients, there were significant positive correlations between several inflammatory and coagulation activation parameters, which were IL-6 with D-dimer and F1+2, CRP with F1+2 and D-dimer as well as TNF-α with F1+2. However, these findings were not shown in DVT patients.
In cancer patients with a high risk of thrombosis, age and D-dimer level are the significant variables towards the incidence of DVT. In patients with DVT, there was no significant correlation between inflammatory and coagulation activation parameters.
深静脉血栓形成（DVT）是癌症患者常见的并发症，也是第二大死亡原因。癌症微环境中的促炎刺激诱导核因子κB（NF-κB）信号通路，该通路在免疫血栓形成机制中起重要作用。
探讨炎症和凝血生物标志物在血栓形成风险高（Khorana评分≥2）的癌症患者发生DVT中的作用。
本研究是在卡里阿迪综合医院进行的一项横断面研究。检测新诊断的血栓形成风险高的癌症患者血清中促炎细胞因子水平，即NF-κB、白细胞介素-6（IL-6）、C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α），以及凝血生物标志物水平，即组织因子（TF）、凝血酶原片段F1+2（F1+2）、纤维蛋白原和D-二聚体。采用彩色双功超声进行DVT筛查。
2021年1月至11月，共有83例符合条件的患者。8例（9.63%）确诊为DVT。单因素分析显示，DVT患者与非DVT患者的中位年龄存在显著差异，分别为49.5岁（范围：23 - 60岁）和42岁（范围：19 - 60岁），p = 0.046。DVT患者的D-二聚体水平更高[（6.020μg/L，范围2.090 - 20.000）vs（1.940μg/L，范围270 - 20.000），p = 0.005]。多因素分析显示年龄和D-二聚体与DVT发生率显著相关。在所有患者中，几种炎症和凝血激活参数之间存在显著正相关，即IL-6与D-二聚体和F1+2、CRP与F1+2和D-二聚体以及TNF-α与F1+2。然而，这些结果在DVT患者中未显示。
在血栓形成风险高的癌症患者中，年龄和D-二聚体水平是DVT发生率的重要变量。在DVT患者中，炎症和凝血激活参数之间无显著相关性。
