多发性骨髓瘤患者高凝状态的实验研究

Hypercoagulable State in Patients with Multiple Myeloma

目的:本研究旨在检测多发性骨髓瘤患者凝血指标血栓调节蛋白(TM)、D-二聚体、纤维蛋白原的表达,并分析疾病不同阶段各指标的变化及其与骨髓中骨髓瘤细胞比例的相关性。方法:采用酶联免疫吸附测定的方法检测45例多发性骨髓瘤患者疾病不同阶段血浆TM的水平;血浆中D-二聚体、纤维蛋白原两项指标采用法国STA全自动血凝分析仪检测。结果:初发组患者血浆TM水平较正常对照组和平台期组显著升高(P<0.01;P<0.05);复发/难治组较正常对照组及化疗达平台期组升高,均具有显著性差异(P<0.05)。同时,沙利度胺联合化疗患者血浆TM水平较初发组显著升高(P<0.05)。骨髓瘤患者血浆D-二聚体、纤维蛋白原均较正常人升高(P<0.01;P<0.05),复发/难治组患者血浆D-二聚体表达最高。同时,沙利度胺联合化疗患者,血浆D-二聚体较初发组患者明显升高(P<0.05)。各凝血指标表达水平与同期骨髓中骨髓瘤细胞比例无明显相关性。结论:多发性骨髓瘤患者血浆TM、D-二聚体、纤维蛋白原的表达较对照组均明显升高,沙利度胺联合化疗使血浆TM、D-二聚体的表达升高,而它们的升高间接提示患者有血栓形成的倾向。

Objective： This study was to detect the plasma thrombomodulin（ TM）, D-dimer and fibrinogen in patients with multiple myeloma（MM） and to analyze their relationship with morbid state, and also to investigate the relationship of the expression of coagulation factor with the ratio of myeloma cells. Methods ： ELISA was used to detect the TM level in 45 cases of MM at different stages. The plasma level of D-dimer and fibrinogen was detected by STA automatic coagulation analyser. Results： The level of plasma TM in newly diagnosed patients was higer than that in normal control group and in platform stage group （ P 〈 0.01 ; P 〈 0.05 ）. There were significant differences between relapsed or refractory group and normal control group or those reached platform stage group （ P 〈 0.05 ）. Meanwhile, the level of plasma TiM in the group of thalidomide combined with chemotherapy was higer than that in newly diagnosed patients （P 〈 0. 05）. The level of plasma D-dimer and fibrinogen of MM patients was higher than that in normal controls （ P 〈 0.01 ;P 〈0.05）. The expression of D-Dimer in relapsed or refractory group reached the maximum. Also, the level of plasma D-Dimer in group of thalidomide combined chemotherapy was higer than in newly diagnosed patients（ P 〈 0.05 ）. The expression of coagulation factor did not correlate with the ratio of myeloma cells. Conclusions： Level of plasma TM, D-Dimer and fibrinogen of MM patients is higher than that in control group. The level of plasma TM and D-Dimer can be elevated when thalidomide used, which indirectly suggested the tendency for thrombosis in MM patients.