预测癌症患者静脉血栓栓塞的生物标记

Biomarkers for Prediction of Venous Thromboembolism in Cancer

癌症患者发生静脉血栓与肺栓塞的危险性增加。为预测不同类型肿瘤患者的静脉血栓栓塞(VTE)发生率,特别研究了一些生物标记。已证实血细胞计数(白细胞与血小板计数升高)是有用的预测因子。D-二聚体、凝血酶原片段1+2、可溶性P-选择素、FⅧ、凝血酶水平升高与未来VTE风险相关。组织因子微粒与VTE风险的关系因肿瘤类型不同而不同:组织因子微粒与胰腺癌VTE风险有相关性已被证实;与胶质母细胞瘤、结直肠癌、胃癌的相关性未获证实。目前建立了包含临床与试验室标记物的预测VTE的风险评估模型,为便于应用抗凝剂预防VTE,危险分层需进一步改进以更好地鉴别VTE患者。

Cancer patients are at increased risk of vein thrombosis and pulmonary embolism.The incidence among different groups of cancer patients varies considerably depending on clinical factors,and the most important one is tumor entity and stage.Biomarkers have been specifically investigated for their capacity of predicting venous thromboembolism （VTE） during the course of disease.Parameters of blood count analysis （elevated leukocyte and platelet count and decreased hemoglobin） have turned out to be useful in risk prediction.Associations between elevated levels and future VTE have been found for D dimer,prothrombin fragment 1 ＋ 2,and soluble P-selectin and also for clotting factor Ⅷ and the thrombin generation potential.The results for tissue factor bearing microparticles are heterogeneous：an association with occurrence of VTE in pancreatic cancer might be present,whereas in other cancer entities,such as glioblastoma,colorectal,or gastric carcinoma,this could not be confirmed.Risk assessment models were developed which included clinical and laboratory markers.A further improvement in risk stratification would allow better identification of patients for primary VTE prevention using indirect or novel direct anticoagulants.