von Tempelhoff G F, Heilmann L, Hommel G, Schneider D, Niemann F, Zoller H
Department of Obstetrics and Gynecology, City Hospital of Russelsheim, Germany.
Cancer. 1998 Mar 15;82(6):1104-11. doi: 10.1002/(sici)1097-0142(19980315)82:6<1104::aid-cncr14>3.0.co;2-a.
In patients with ovarian carcinoma, an hematocrit-independent hyperviscosity syndrome is often present. The syndrome is characterized by normal or low hematocrit and hemoglobin concentration, an elevated platelet count, and an increase in clotting factor turnover. Because deep vein thrombosis (DVT) often complicates the course of ovarian carcinoma, the aim of this study was to investigate the possible association of hyperviscosity syndrome with the development of DVT.
Rheologic estimations of the blood included red blood cell (RBC) aggregation (stasis and low shear), plasma viscosity (pv), blood cell count, and fibrinogen, which were performed before primary surgery and the beginning of perioperative heparin thrombosis prophylaxis on 63 of 65 patients with Stage I-IV ovarian malignancy (according to the staging criteria of the International Federation of Gynecology and Obstetrics). Two patients who had had DVT 5-6 weeks in advance of the study were excluded from rheologic calculations. Thrombosis screening by impedance plethysmography was performed the day before primary major surgery; postoperatively on Days 1, 3, 5, 7, and 10; before each of 6 cycles of chemotherapy (once every 3 weeks); and thereafter once every 3 months during follow-up. All blood tests were also performed on 72 healthy women and 29 patients with benign ovarian tumor the day prior to surgery.
All ovarian carcinoma patients, including 7 patients with tumors of low malignant potential, were eligible for surgery, and all except those with Stage IV disease (n = 12) were macroscopically tumor free after surgery. Before surgery, RBC aggregation, pv, and platelet and fibrinogen concentrations were significantly higher (P < 0.05) in cancer patients than in either of the control groups, whereas hemoglobin (hb) and hematocrit (hct) were significantly lower in cancer patients than in healthy women (P < 0.001). Platelet, leukocyte, and fibrinogen concentrations were significantly correlated to disease stage, whereas pv, RBC aggregation, hb, and hct were not. The preoperative pv was significantly higher in patients who later developed DVT (n = 17; 1.46+/-0.13 mPas; P = 0.01) than in those who did not (1.34+/-0.14 mPas). Of all estimated preoperative variables, only pv was a significant risk factor for postoperative and subsequent DVT (RR: 29.84; 95% CI: 1.076-827.16; P = 0.04).
Our results confirm the presence of a hematocrit- and stage-independent hyperviscosity syndrome in untreated ovarian carcinoma patients. In addition, a high preoperative plasma viscosity was a significant risk factor for the development of DVT in the postoperative period and even thereafter.
在卵巢癌患者中，常出现一种与血细胞比容无关的高黏滞综合征。该综合征的特征是血细胞比容和血红蛋白浓度正常或降低、血小板计数升高以及凝血因子周转率增加。由于深静脉血栓形成（DVT）常使卵巢癌病程复杂化，本研究旨在探讨高黏滞综合征与DVT发生之间的可能关联。
对65例I-IV期卵巢恶性肿瘤患者（根据国际妇产科联合会的分期标准）中的63例，在初次手术前及围手术期肝素血栓预防开始前进行血液流变学评估，包括红细胞（RBC）聚集（静态和低切变率）、血浆黏度（pv）、血细胞计数和纤维蛋白原。两名在研究前5-6周发生DVT的患者被排除在血液流变学计算之外。在初次大手术前一天通过阻抗体积描记法进行血栓形成筛查；术后第1、3、5、7和10天；在6个化疗周期（每3周一次）的每个周期之前；以及随访期间此后每3个月进行一次。所有血液检查也在72名健康女性和29例良性卵巢肿瘤患者手术前一天进行。
所有卵巢癌患者，包括7例低恶性潜能肿瘤患者，均符合手术条件，除IV期疾病患者（n = 12）外，所有患者术后肉眼可见无肿瘤。手术前，癌症患者的RBC聚集、pv以及血小板和纤维蛋白原浓度显著高于两个对照组中的任何一组（P < 0.05），而癌症患者的血红蛋白（hb）和血细胞比容（hct）显著低于健康女性（P < 0.001）。血小板、白细胞和纤维蛋白原浓度与疾病分期显著相关，而pv、RBC聚集、hb和hct则无相关性。术后发生DVT的患者（n = 17；1.46±0.13 mPas；P = 0.01）术前pv显著高于未发生DVT的患者（1.34±0.14 mPas）。在所有术前评估变量中，只有pv是术后及随后发生DVT的显著危险因素（RR：29.84；95% CI：1.076 - 827.16；P = 0.04）。
我们的结果证实未治疗的卵巢癌患者存在与血细胞比容和分期无关的高黏滞综合征。此外，术前高血浆黏度是术后甚至此后发生DVT的显著危险因素。
