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恶性肿瘤使止血系统发生显著改变。50％癌症病人和约95％转移性肿瘤病人可检测到止血系统的一些实验室指标异常,其中9～15％发展为弥漫性血管内凝血(DIC),引起致命后果——血栓或出血。据报告,1～11％恶性肿瘤病人发生血栓栓塞,尸检报导更高。约10％癌症病人发生出血,其中1/2由化疗所致血小板减少引起,1/3是因肿瘤直接侵袭,仅约10％系DIC所致。总之,血栓栓塞和出血是癌症病人死亡的第二大原因。癌症与止血系统的相互作用是复杂的,本文将讨论(1)其相互作用的病理生理学;(2)这些变化引起的临床综合征;(3)该临床综合征的处理。
Malignant tumors cause a significant change in the hemostatic system. 50% of cancer patients and about 95% of metastatic tumor patients can detect some abnormal laboratory parameters of the hemostatic system, and 9-15% of them develop diffuse intravascular coagulation (DIC), causing fatal consequences—thrombosis or hemorrhage. According to reports, thromboembolism occurs in 1 to 11% of patients with malignant tumors, and autopsy reports are even higher. About 10% of cancer patients experience bleeding, of which 1/2 is caused by chemotherapy-induced thrombocytopenia, 1/3 is due to direct tumor invasion, and only about 10% is due to DIC. In conclusion, thromboembolism and hemorrhage are the second leading cause of death in cancer patients. The interaction of cancer with the hemostatic system is complex. This article will discuss (1) the pathophysiology of their interactions; (2) the clinical syndrome caused by these changes; and (3) the treatment of this clinical syndrome.