沙利度胺对多发性骨髓瘤患者止凝血功能的影响

Influences of Thalidomide on Haemostatic Function in Patients with Multiple Myeloma

目的探究沙利度胺对多发性骨髓瘤患者止凝血功能的影响。方法动态检测和比较20例多发性骨髓瘤患者服用沙利度胺前后血浆内皮素-1、凝血酶调节蛋白和血小板α颗粒膜蛋白-140水平以及凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅸ、Ⅹ、Ⅺ活性,抗凝血酶活性,纤维蛋白原含量,血浆D-二聚体、组织型纤溶酶原激活物、纤溶酶原激活抑制物-1、α_2-抗纤溶酶抑制物的活性。结果服用沙利度胺后,多发性骨髓瘤患者体内血浆内皮素-1、凝血酶调节蛋白水平以及血浆D-二聚体比治疗前显著升高(P＜0．05或P＜0．01),而抗凝血酶活性比治疗前明显降低(P＜0．05),其余指标无明显改变。结论沙利度胺可能通过影响血管内皮细胞功能和调节抗凝及纤溶活性而增加多发性骨髓瘤患者并发动静脉血栓的风险。

Objective To investigate the influences of thalidomide on haemostatic function in patients with multiple myeloma. Methods We evaluated makers of haemostatic function,including serum levels of endothelin-1 ,thrombomodulin, platelet a-granule membrane protein-140, fibrinogen and its degradation products D-dimer as well as activities of coagulation factors Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅸ、Ⅹ、Ⅺ, antithrombin, tissue plasminogen activator, plasminogen activator inhibitor and α2-plasmin inhibitor, during treatment with thalidomide in 20 patients with multiple myeloma. Results It was found that the serum levels of endothelin-1 ,thrombomodulin as well as D-dimer significantly increased （P 〈0.05 or P 〈0.001 ） ,while the activities of antithrombin dramatically decreased （P 〈 0.05 ） in patients with multiple myeloma after receiving thalidomide. Other parameters were not affected by thalidomide. Conclusion Thalidomide might increase risk of arterial or venous thrombosis in patients with multiple myeloma through modulation of endothelium function as well as activities of anticoagulation and fibrionlysis.