含硼替佐米方案对多发性骨髓瘤患者出凝血功能及循环中微颗粒水平的影响

Effects of bortezomib-based therapy on hemostasis system and circulating microparticles in multiple myeloma patients

目的:研究采用含硼替佐米方案(PAD)诱导治疗的多发性骨髓瘤(MM)患者出凝血功能及循环中总微颗粒(TMPs)水平的变化特点。方法:使用流式细胞术检测38例新诊断MM患者和30例健康志愿者TMPs水平,观察MM患者PAD治疗前后血小板、凝血、抗凝、纤溶功能和TMPs的改变。结果:治疗前MM患者FVIII:C和vWF:Rco升高[(152.89±31.14)%和(165.69±38.43)%];血小板聚集功能下降[(63.76±21.36)%];PAI升高[3.98(1.63)U/mL];TMPs较健康对照组升高[(640.65±214.22)μL vs(134.29±63.09)μL,P<0.01],并与β2-MG正相关(r=0.672,P<0.01)。PAD治疗后,血小板聚集功能恢复[(77.83±15.62)%,P=0.01];PAI异常得到纠正[0.88(1.38)U/mL,P<0.01];TMPs也进行性下降,3疗程PAD后降至(184.25±93.35)/μL(P<0.01)。结论:MM患者本身具有血小板、凝血、纤溶异常和TMPs水平升高;PAD方案使疾病缓解同时恢复患者血小板功能,纠正纤溶异常,并降低TMPs水平,以上改变可能是采用含硼替佐米方案治疗的MM患者血栓发生率低的部分原因。

AIM： To investigate the changes of hemostasis, thrombosis and total mieroparticles （TMPs） in multiple myeloma （ MM） patients receiving bortezomib-hased induction therapy （horteznmih ＋ adriamycin ＋ dexamethasone, PAD）. METHODS： The levels ofTMPs were detected by flow cytometry in 38 newly diagnosed MM patients and 30 healthy people. The changes of the platelet, coagulation, anticoagulation, fihrinolytic activation and TMPs in the MM patients before and after PAD teatment were also studied. RESULTS： Before treatment, the values of FVIIl：C and vWF：Reo in MM patient were elevated [（ 152. 89 ± 31. 14） % and （ 165.69 ± 38.43） % ] , the activation of platelet aggregation was inhibited [ （63. 76 ± 21. 36） % ] , and the PAl level increased [3. 98 （ 1. 63 ） U/mL]. Compared with the healthy people. higher concentration of TMPs was observed in MM patients [（ 640.65 ± 214. 22 ）/ μL vs （ 134.29 ± 63. 09 ）/μL. P 〈 0.01] , and the level of TMPs was positively correlated with serum β2-MG （r = 0.672, P 〈 0. 01 ）. After PAD therapy, platelet aggregation activation was reslore.l [（ 77.83 ± 15.62） %, P = 0. 01 ], and PAl level decreased [0.88 （ 1. 38 ） UI mL, P 〈 0. 01 ]. The level of TMPs also decreased, after 3 cycles of PAD, to the value of （ 184. 25 ± 93. 35 ） /μL. CONCLUSION： MM patients were eharacterized by impaired platelet, coagulation and fibrinolysis functions , and increased level of TMPs. PAD restored platelet function, decreased the levels of PAl and TMPs, which might partially explain the low incidence of thrombosis in the MM patients receiving bortezomih-hased treatment.