门冬酰胺酶对白血病患儿静脉血栓形成的研究进展

Advances in the Treatment of Venous Thrombosis in Children with Leukemia by Asparaginase

门冬酰胺酶在联合化疗中的应用使儿童急性淋巴细胞性白血病成为可治愈的恶性肿瘤。但ASP导致血栓形成可影响患者化疗进程,降低化疗缓解率。静脉血栓形成的发病率在1%~36%,主要取决于患者年龄、治疗方案、血栓筛检方法的不同。血栓形成的部位主要在上肢静脉,尤其是中心静脉导管。ASP导致血栓形成的机制是通过降低AT-Ⅲ水平,及激活血小板和内皮细胞。年龄、中心静脉导管、激素及遗传因素均是影响血栓发生的高危因素。预防性使用AT-Ⅲ或LWMH可降低静脉血栓形成的风险。新型口服抗凝药物,是凝血酶或Xa因子直接抑制剂,其抗凝效果不依赖AT-Ⅲ水平,由此推测,新型抗凝剂比传统抗凝剂在预防门冬酰胺酶相关性血栓形成更为有效和更便于临床应用。

Application of asparaginase in combination chemotherapy makes childhood acute lymphoblastic leukemia a curable malignant tumor.However,ASP caused thrombosis can affect the chemotherapy process and reduce the remission rate of chemotherapy.The incidence of venous thrombosis varies from 1%-36%,depending on the age of patients,treatment options,and screening methods for thrombosis.The site of thrombosis is mainly in the veins of the upper extremities,especially the central venous catheters.The mechanism by which ASP causes thrombosis is by lowering AT-III levels and activating platelets and endothelial cells. Age,central venous catheter,hormones and genetic factors are all high risk factors for thrombosis.Prophylactic use of AT-III or LWMH reduces the risk of venous thrombosis.The new anticoagulant is a direct inhibitor of thrombin or Xa factor.Its anticoagulant effect does not depend on the level of AT-III.Thus,it is speculated that the new anticoagulant is more effective and more convenient for clinical application than the traditional anticoagulant in preventing the formation of asparaginase related thrombus.