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摘要: 静脉血栓栓塞(venous thrombolism,VTE)是恶性肿瘤患者第二致死原因,并且癌症患者是血栓栓塞的高发人群,其预防和治疗是非常重要的。肿瘤患者发生VTE的风险较非肿瘤患者至少增加7倍,而血液系统肿瘤并发VTE的概率则较非肿瘤患者增加28倍,严重影响了恶性淋巴瘤患者的预后和生活质量。恶性淋巴瘤患者并发VTE的机制和危险因素尚未明确,VTE的发生与组织因子、微粒以及基因的单核苷酸多态性相关。为了降低VTE发生率,预测可能发生VTE的高危患者是非常重要的,这些患者将会从血栓预防中受益,因此临床上急需一种简单有效的VTE风险评估模型,联合检测外周血中生物标记物可提高VTE诊断率。由于淋巴瘤患者发生出血的风险较高,导致血栓的治疗更加复杂。本文就恶性淋巴瘤患者发生VTE的流行病学、发病机制、预防和治疗的最新研究做一综述。Abstract: Venous thromboembolism (VTE) is the second leading cause of death and is a major cause of morbidity in patients with cancer. The prevention and the treatment of VTE are important. The risk of thrombosis among cancer patients is increaseds by seven times, but this risk may be 28 times higher in patients with hematological tumors. This increased risk seriously affects the quality of life and the prognosis of malignant lymphoma patients. However, the pathogenesis and risk factors for VTE in the lymphoma patients are not well well-defined. This study reveals that tissue factors, micro-particles, and single nucleotide polymorphisms of gene are associated with VTE. Therefore, the identification of patients with the highest risk of VTE is important to improve the diagnostic rate of VTE. These patients would benefit from thrombo-prophylaxis. We therefore need a simple and effectual risk assessment model for predicting the incidence rates of VTE. Moreover, peripheral blood biomarkers might improve the accuracy of the diagnosis. Patients with lymphoma have a high risk for hemorrhage, and receiving anticoagulant therapy is challenging for them. This review summarizes the current knowledge of the epidemiology, pathogenesis, prophylaxis, and treatment of VTE in patients with lymphoma.
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Key words:
- venous thrombolism thrombus /
- malignant lymphoma /
- prophylaxis /
- treatment
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[1] Goldschmidt N, Linetsky E, Shalom E, et al. High incidence of thromboembolism in patients with central nervous system lymphoma[J]. Cancer, 2003, 98(6):1239-1242. doi: 10.1002/cncr.11623 [2] Yokoyama K, Murata M, Ikeda Y, et al. Incidence and risk factors for developing venous thromboembolism in Japanese with diffuse large B-cell lymphoma[J]. Thromb Res, 2012, 130(1):7-11. https://www.sciencedirect.com/science/article/pii/S0049384811005093 [3] Caruso V, Di Castelnuovo A, Meschengieser S, et al. Thrombotic complications in adult patients with lymphoma: a meta-analysis of 29 independent cohorts including 18 018 patients and 1149 events[J]. Blood, 2010, 115(26):5322-5328. http://www.ncbi.nlm.nih.gov/pubmed/20378755 [4] 刘鹏飞, 李亚妮, 李兰芳, 等.淋巴瘤相关血栓的临床分析[J].中国肿瘤临床, 2013, 40(10):596-599. http://www.cjco.cn/cn/article/doi/doi:10.3969/j.issn.1000-8179.2013.10.011Pengfei Liu, Yani Li, Langfan Li, et al. Clinical features of lymphoma-related thrombosis[J]. Chin J Clin Oncol, 2013, 40(10): 596-599. http://www.cjco.cn/cn/article/doi/doi:10.3969/j.issn.1000-8179.2013.10.011 [5] Park LC, Woo SY, Kim S, et al. Incidence, risk factors and clinical features of venous thromboembolism in newly diagnosed lymphoma patients: results from a prospective cohort study with Asian population[J]. Thromb Res, 2012, 130(3):e6-e12. http://www.ncbi.nlm.nih.gov/pubmed/22507288 [6] Reitsma PH, Versteeg HH, Middeldorp S. Mechanistic view of risk factors for venous thromboembolism[J]. Arterioscler Thromb Vasc Biol, 2012, 32(3):563-568. http://www.ncbi.nlm.nih.gov/pubmed/22345594 [7] Rak J, Milsom C, May L, et al. Tissue factor in cancer and angiogenesis: the molecular link between genetic tumor progression, tumor neovascularization, and cancer coagulopathy[J]. Semin Thromb He most, 2006, 32(1):54-70. http://europepmc.org/abstract/MED/16479463 [8] Sartori MT, Della Puppa A, Ballin A, et al. Prothrombotic state in glioblastoma multiforme: an evaluation of the procoagulant activity of circulating microparticles[J]. J Neurooncol, 2011, 104(1):225-231. doi: 10.1007/s11060-010-0462-8 [9] Roselli M, Ferroni P, Rolfo C, et al. TNF-α gene promoter polymorphisms and risk of venous thromboembolism in gastrointestinal cancer patients undergoing chemotherapy[J]. Ann Oncol, 2013, 24 (10):2571-2575. https://academic.oup.com/annonc/article/24/10/2571/176733 [10] Gonsalves A, Carrier M, Wells PS, et al. Incidence of symptomatic venous thromboembolism following hematopoietic stem cell transplantation[J]. J Thromb Haemost, 2008, 6(9):1468-1473. http://labs.europepmc.org/abstract/MED/18627443 [11] Gerber DE, Segal JB, Levy MY, et al. The incidence of and risk factors for venous thromboembolism (VTE) and bleeding among 1 514 patients undergoing hematopoietic stem cell transplantation: implications for VTE prevention[J]. Blood, 2008, 112(3):504-510. http://www.sciencedirect.com/science/article/pii/S0006497120603925 [12] Khorana AA, Kuderer NM, Culakova E, et al. Development and validation of a predictive model for chemotherapy-associated thrombosis[J]. Blood, 2008, 111(10):4902-4907. https://pubmed.ncbi.nlm.nih.gov/18216292/ [13] Ay C, Dunkler D, Marosi C, et al. Prediction of venous thromboembolism in cancer patients[J]. Blood, 2010, 116(24):5377-5382. http://eurheartj.oxfordjournals.org/lookup/ijlink?linkType=ABST&journalCode=bloodjournal&resid=116/24/5377&atom=%2Fehj%2F34%2F15%2F1102.atom [14] van Montfoort ML, Stephan F, Lauw MN, et al. Circulating nucleosomes and neutrophil activation as risk factors for deep vein thrombosis[J].Arterioscler Thromb Vasc Biol, 2013, 33(1):147-151. doi: 10.1161/ATVBAHA.112.300498 [15] Ramacciotti E, Blackburn S, Hawley AE, et al. Evaluation of soluble P-Selectin as a marker for the diagnosis of deep venous thrombosis[J]. Clin Appl Thromb Hemost, 2011, 17(4):425-431. http://labs.europepmc.org/abstract/MED/21593019 [16] Cortelezzi A, Moia M, Falanga A, et al. Incidence of thrombotic complications in patients with haematological malignancies with central venous catheters: a prospective multicentre study[J]. Br J Haematol, 2005, 129(6):811-817. http://www.ncbi.nlm.nih.gov/pubmed/15953009 [17] Couban S, Goodyear M, Burnell M, et al. Randomized placebo-controlled study of low-dose warfarin for the prevention of central venous catheterassociated thrombosis in patients with cancer[J]. J Clin Oncol, 2005, 23(18):4063-4069. https://www.academia.edu/2559811/Randomized_placebo_controlled_study_of_low_dose_warfarin_for_the_prevention_of_central_venous_catheter_associated_thrombosis_in_patients_with_cancer [18] Streiff MB, Bockenstedt PL, Cataland SR, et al. Venous thromboembolic disease[J]. J Natl Compr Canc Netw, 2013, 11(11):1402-1429. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_PM21715723 [19] Agnelli G, Becattini C, Franco L. New oral anticoagulants for the treatment of venous thromboembolism[J]. Best Pract Res Clin Haematol, 2013, 26(2):151-161. https://www.sciencedirect.com/science/article/pii/S1521692613000261 [20] Che DH, Cao JY, Shang LH, et al. The efficacy and safety of low-molecular-weight heparin use for cancer treatment: a meta-analysis[J]. Eur J Intern Med, 2013, 24(5):433-439. https://www.sciencedirect.com/science/article/pii/S0953620513000113 [21] Rickles FR, Falanga A, Montesinos P, et al. Bleeding and thrombosis in acute leukemia: what does the future of therapy look like[J]? Thromb Res, 2007, 120(Suppl 2):S99-106. https://www.sciencedirect.com/science/article/pii/S0049384807701378
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