C 型凝集素样受体 2 水平与血小板计数比值（C2PAC）升高有助于 IDH 野生型脑胶质瘤术后静脉血栓栓塞症的诊断。

Elevated ratio of C-type lectin-like receptor 2 level and platelet count (C2PAC) aids in the diagnosis of post-operative venous thromboembolism in IDH-wildtype gliomas.

机构信息

Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.

出版信息

Thromb Res. 2023 Mar;223:36-43. doi: 10.1016/j.thromres.2023.01.018. Epub 2023 Jan 21.

DOI:10.1016/j.thromres.2023.01.018

PMID:36706720

Abstract

INTRODUCTION

Podoplanin (PDPN) is known to induce platelet aggregation via interacting with the C-type lectin-like receptor-2 on platelets and is involved in postoperative venous thromboembolism (VTE) formation. In this study, we investigate the correlation between soluble C-type lectin-like receptor (sCLEC-2) levels and PDPN expression in patients with high grade gliomas and the relationship between sCLEC-2 levels and the occurrence of VTE.

MATERIALS AND METHODS

Forty-four patients harboring high grade gliomas, treated surgically at the Department of Neurosurgery, Niigata University from April 2018 to August 2020, were included. Patients with high grade gliomas were divided into isocitrate dehydrogenase (IDH)- wildtype and mutant groups, and the presence or absence of VTE and the intensity of PDPN by immunohistochemistry were confirmed. Platelet counts, as well as plasma sCLEC-2 and PDPN were measured in these patients. Furthermore, the levels of sCLEC-2 concentration were divided by the platelet count (C2PAC index) for comparison.

RESULTS

IDH-wildtype glioma patients highly expressed PDPN (P < 0.001) compared to IDH-mutant glioma patients. In total, 9 (20.5 %) patients were diagnosed with VTE during the follow-up period, of which 8 patients harbored IDH-wildtype gliomas, and one patient an IDH-mutant glioma. Mean sCLEC-2 levels and C2PAC index in patients with IDH-wildtype gliomas were significantly higher than that of low or no PDPN expression group, which included patients with IDH-mutant gliomas (P = 0.0004, P = 0.0002). In patients with IDH-wildtype gliomas, the C2PAC index in patients with VTE was significantly higher than in patients without VTE (P = 0.0492). The optimal cutoff point of C2PAC for predicting VTE in IDH-wildtype glioma patients was 3.7 with a sensitivity of 87.5 % and specificity of 51.9 %.

CONCLUSION

Platelet activation is strongly involved in the development of VTE in patients with IDH-wildtype high grade gliomas, and C2PAC index is a potential marker to detect VTE formation after surgery.

摘要

简介

Podoplanin (PDPN) 已知通过与血小板上的 C 型凝集素样受体-2 相互作用诱导血小板聚集，并参与术后静脉血栓栓塞 (VTE) 的形成。在这项研究中，我们研究了高级别神经胶质瘤患者可溶性 C 型凝集素样受体 (sCLEC-2) 水平与 PDPN 表达之间的相关性，以及 sCLEC-2 水平与 VTE 发生的关系。

材料和方法

纳入 2018 年 4 月至 2020 年 8 月在新泻大学神经外科接受手术治疗的 44 例高级别神经胶质瘤患者。将高级别神经胶质瘤患者分为异柠檬酸脱氢酶 (IDH)-野生型和突变型组，并通过免疫组织化学证实 VTE 的存在和 PDPN 的强度。测量这些患者的血小板计数以及血浆 sCLEC-2 和 PDPN。此外，通过血小板计数（C2PAC 指数）对 sCLEC-2 浓度水平进行划分并进行比较。

结果

与 IDH 突变型神经胶质瘤患者相比，IDH 野生型神经胶质瘤患者的 PDPN 表达水平较高（P < 0.001）。在随访期间，共有 9 例（20.5%）患者诊断为 VTE，其中 8 例患者为 IDH 野生型神经胶质瘤，1 例患者为 IDH 突变型神经胶质瘤。IDH 野生型神经胶质瘤患者的 sCLEC-2 水平和 C2PAC 指数均显著高于低或无 PDPN 表达组（包括 IDH 突变型神经胶质瘤患者）（P = 0.0004，P = 0.0002）。在 IDH 野生型神经胶质瘤患者中，发生 VTE 的患者的 C2PAC 指数明显高于未发生 VTE 的患者（P = 0.0492）。IDH 野生型神经胶质瘤患者中，C2PAC 预测 VTE 的最佳截断点为 3.7，灵敏度为 87.5%，特异性为 51.9%。