内源性凝血酶潜能作为卵巢癌静脉血栓栓塞的一个标志物

　　ENDOGENOUS THROMBIN POTENTIAL AS A MARKER FOR VENOUS THROMBOEMBOLISM IN OVARIAN CANCER

　　F. Abu Saadeh^1,2, L. Norris¹, S. O'Toole¹, R. Langhe¹, N. Gleeson^1,2

　　¹Department of Obstetrics & Gynaecology, Trinity College Dublin, ²Department of Gynaecology Oncology, St. James's Hospital, Dublin, Ireland

　　Introduction: Gynaecological cancers are associated with an increased risk of venous thromboembolism (VTE). Endogenous Thrombin Potential (ETP) has shown potential as a predictive marker for VTE.

　　Aim: To compare the procoagulant activity in plasma of patients with benign and malignant lesions of ovary using the (ETP) assay.

　　Patients and methods: Blood samples were obtained from 89 patients with ovarian tumours ( 29 benign and 60 malignant). Thrombin generation in platelet-poor plasma was measured using the Calibrated Automated Thrombography. Lag time, peak thrombin production, area under the thrombin generation curve (ETP), time to peak (TTP) were determined.

　　Results: Patients with ovarian clear cell carcinoma had higher peak thrombin production (p< 0.01) and greater ETP( p< 0.001)compared with benign ovarian tumours. In the neoadjuvant group peak thrombin production following thrombomodulin incubation was significantly higher than in the benign ovarian group (p< 0.01). In patients who developed VTE post surgery, higher levels of ETP and peak thrombin (p< 0.01) were found preoperatively compared with patients who did not develop VTE.

　　Conclusions: Patients with clear cell cancer have increased procoagulant activity as measured by ETP assay. The increased procoagulant activity is likely to contribute to the higher incidence of VTE in these patients. This procoagulant activity may be caused by the increased TF expression by tumour tissue (which we have reported). Following chemotherapy patients have reduced sensitivity to thrombomodulin indicating a defect in the protein C inhibitory pathway. ETP may be a potential marker for VTE in Gynaecology oncology patients post surgery.

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