Dragoni F, Mazzucconi M G, Acqui M, Ferrante L, Rosa G, Mastronardi L, Chistolini A, de Sanctis V, Mandelli F
Department of Human Biopathology, University 'La Sapienza', Rome, Italy.
Haemostasis. 1993 Nov-Dec;23(6):301-7. doi: 10.1159/000216892.
Abnormal fibrinolysis and thrombotic complications have been often observed in patients who had undergone surgery for meningioma. Fourteen patients, affected by meningioma, were studied before surgery, during surgery and 24 h after surgery in order to evaluate the modifications of the fibrinolysis system and the coagulation physiological inhibitors. Before surgery, no patient showed hyperfibrinolysis and/or modifications of coagulation physiological inhibitors. During surgery, an activation of fibrinolysis with pathological levels of tissue plasminogen activator activity (mean = 6.33 U/dl, SD = 7.9, p = 0.02) and increased levels of fibrin degradation products (mean = 0.21, SD = 0.18, p = 0.002) was noted. Modifications of the fibrinolysis parameters occurred only in 9/14 patients (64%). These patients presented a more vascularized tumour, revealed before surgery by computerized tomography scan and cerebral arteriography and directly confirmed during the resection. Twenty-four hours after surgery no patient presented fibrinolysis activation. There was no evidence of disseminated intravascular coagulation in our patients. None of them presented pathological decrease of the physiological coagulation inhibitors or thrombotic complications. In conclusion, during surgery, fibrinolysis parameters show important modifications in patients with vascularized meningioma suggesting an ongoing tumour-host interaction. These variations must be taken in account, in order to plan timely a correct therapeutic approach.
在接受脑膜瘤手术的患者中，常观察到异常纤维蛋白溶解和血栓形成并发症。对14例脑膜瘤患者在手术前、手术期间和手术后24小时进行了研究，以评估纤维蛋白溶解系统和凝血生理抑制剂的变化。手术前，没有患者出现高纤维蛋白溶解和/或凝血生理抑制剂的改变。手术期间，观察到纤维蛋白溶解激活，组织纤溶酶原激活物活性达到病理水平（平均值=6.33 U/dl，标准差=7.9，p=0.02），纤维蛋白降解产物水平升高（平均值=0.21，标准差=0.18，p=0.002）。纤维蛋白溶解参数的改变仅发生在9/14例患者（64%）中。这些患者的肿瘤血管化程度更高，术前通过计算机断层扫描和脑血管造影显示，并在切除过程中得到直接证实。手术后24小时，没有患者出现纤维蛋白溶解激活。我们的患者中没有弥散性血管内凝血的证据。他们中没有一人出现生理性凝血抑制剂的病理性降低或血栓形成并发症。总之，手术期间，血管化脑膜瘤患者的纤维蛋白溶解参数显示出重要变化，提示肿瘤与宿主之间存在持续的相互作用。为了及时制定正确的治疗方案，必须考虑这些变化。
