Gruppo R, Glueck C J, McMahon R E, Bouquot J, Rabinovich B A, Becker A, Tracy T, Wang P
Division of Hematology/Oncology, Children's Hospital Medical Center, Cincinnati, OH USA.
J Lab Clin Med. 1996 May;127(5):481-8. doi: 10.1016/s0022-2143(96)90065-7.
We studied 55 patients (50 women, 5 men) with severe facial pain and biopsy-proven neuralgia-inducing cavitational osteonecrosis (NICO) of the alveolar bone of the jaws. Our aim was to assess the pathophysiologic contributions to NICO of anticardiolipin antibodies (aCLA), thrombophilia (increased tendency to intravascular thrombi), and hypofibrinolysis (reduced ability to lyse thrombi). Of the 55 patients, 43 (78%) had one or more tests positive for thrombophilia or hypofibrinolysis (or both), and only 12 (22%) were normal. Eighteen of 55 (33%) patients had high aCLA (> 2 SD above mean value for control subjects); immunoglobulin G (IgG) (p = 0.01) and immunoglobulin A (IgA)(p = 0.001) levels were higher in patients than in controls. The distribution of elevated aCLA immunoglobulin classes among patients was as follows: IgG alone, 5 (9%); IgA alone, 7 (13%); and IgM alone, 3 (5%). Three patients (5%) had high levels of both IgG and IgA aCLA. Other defects of the thrombotic or fibrinolytic systems in the 55 patients included high lipoprotein(a) in 36% (vs 20% in control subjects (p = 0.03)), low stimulated tissue plasminogen activator activity (tPA-Fx) in 22% (vs 7% in control subjects (p = 0.08)), high plasminogen activator inhibitor activity (PAI-Fx) in 18% (vs 8% in control subjects (p = 0.03)), resistance to activated protein C in 16% (vs 0% in control subjects (p = 0.007)), low antigenic protein C in 4+ (vs 0% in control subjects (p > 0.2)), and low antigenic protein S in 4% (vs 0% in control subjects (p > 0.2)). Anticardiolipin antibodies and other defects of the thrombotic and fibrinolytic systems appear to be common, potentially reversible pathogenetic risk factors associated with osteonecrosis of the jaw.
我们研究了55例（50名女性，5名男性）患有严重面部疼痛且经活检证实为颌骨牙槽骨神经痛性空洞性骨坏死（NICO）的患者。我们的目的是评估抗心磷脂抗体（aCLA）、血栓形成倾向（血管内血栓形成倾向增加）和纤维蛋白溶解功能减退（溶解血栓能力降低）对NICO的病理生理影响。在这55例患者中，43例（78%）一项或多项血栓形成倾向或纤维蛋白溶解功能减退检测呈阳性（或两者皆阳性），只有12例（22%）检测结果正常。55例患者中有18例（33%）aCLA水平较高（高于对照受试者平均值2个标准差以上）；患者的免疫球蛋白G（IgG）（p = 0.01）和免疫球蛋白A（IgA）（p = 0.001）水平高于对照组。患者中aCLA免疫球蛋白类别升高的分布情况如下：单独IgG升高，5例（9%）；单独IgA升高，7例（13%）；单独IgM升高，3例（5%）。3例患者（5%）IgG和IgA aCLA水平均较高。55例患者血栓形成或纤维蛋白溶解系统的其他缺陷包括：36%的患者脂蛋白(a)水平较高（对照受试者为20%，p = 0.03），22%的患者刺激的组织纤溶酶原激活物活性（tPA-Fx）较低（对照受试者为7%，p = 0.08），18%的患者纤溶酶原激活物抑制剂活性（PAI-Fx）较高（对照受试者为8%，p = 0.03），16%的患者对活化蛋白C有抵抗（对照受试者为0%，p = 0.007），4%的患者抗原性蛋白C水平较低（对照受试者为0%，p > 0.2），4%的患者抗原性蛋白S水平较低（对照受试者为0%，p > 0.2）。抗心磷脂抗体以及血栓形成和纤维蛋白溶解系统的其他缺陷似乎是常见的、潜在可逆的与颌骨骨坏死相关的致病危险因素。
