RESUMO
Thrombosis triggers, in addition to «classic¼ risk factors (RFs) of cardiovascular events, includes the reactive changesof peripheral blood (RCPB), markers of the hereditary thrombophilia and radiation anamnesis. However, results ofmost studies suggest the «classic¼ RFs are able to neutralize the prothrombogenic potential of the hereditary thrombophilia and other, less powerful predictors of thrombosis. OBJECTIVE: to determine the influence of the G1691A allele of the proaccelerin gene carrying to the thrombosis development, taking into account the vascular type of their occurrence, the presence of RFs in individuals with RCPB (reactive leukocytosis and thrombocytosis, and secondary erythrocytosis), as well as with and without radiation anamnesis. MATERIAL AND METHODS: In general, it was analyzed the results of clinical and molecular-genetic data of 152 patientswith RCPB, 19 patients had radiation anamnesis, 133 - did not have. The thrombotic complications were detected in5 (26.31 %) of radiation-exposer patients and 25 (18.79 %) patients without radiation anamneses. The carrying ofthe G1691A allele proaccelerin gene (APG) (Leiden mutation (LM)) was detected using the allele-specific polymerasechain reaction. RESULTS: The LM was found in 5.9 % (9 carriers) of the general cohort (GC) of RPBC patients. There were no differencein the LM frequency between the groups of patients with and without radiation anamnesis (Ñ = 0.312). In the groupof radiation-exposer patients (Ñ = 0.017), as well as in the group without its (Ñ = 0.031), venous thromboses only weremore frequently in the LM carriers. In the presence of a radiation anamnesis, G1691A APG carriers with RFs have thehigher frequency (Ñ = 0.008) and the probability of the occurrence (relative risk [RR] = 25.00; CI 95 %: 1.56-399.68)of venous thrombosis. In the group without radiation anamnesis, the frequency of venues thrombosis in the LMcarriers is higher in the younger age subgroup (Ñ = 0.001), without RFs (p = 0.044) and without RFs under 60 years(Ñ = 0.023). The risk of venous thrombosis in the G1691A APG carriers of the group without radiation anamnesis is5.78 (95 % CI: 1.58-21.13). In LM carriers without radiation anamnesis and RFs, as well as under the 60 years of age,the probability of venous thrombosis was 6.85 (95 % CI: 1.86-25.22) and 19.40 (95 % CI: 4.64-81.09), respectively,and in the absence of both criteria - 9.57 (95 % CI: 2.49-36.73). CONCLUSIONS: In patients with and without radiation anamnesis, the risk of venues thrombosis are observed moreoften in carriers of LM. The carrying of the G1691A APG in patients with RPBC and without RA increased the risk ofvenues thrombosis development in subjects without FRs and below 60 years of age. In the radiation-exposure group,the frequency and the risk of venues thrombosis in the G1691A APG carriers was higher in the subgroup with RFs. It isprobably due to the peculiarity of the samples, or prothrombogenic interaction between LM and radiation-associated endothelial damage.
Assuntos
Acidente Nuclear de Chernobyl , Fator V/genética , Exposição à Radiação/efeitos adversos , Trombose Venosa/genética , Idoso , Poluentes Radioativos do Ar/efeitos adversos , Alelos , Socorristas , Feminino , Expressão Gênica , Predisposição Genética para Doença , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Prognóstico , Radiação Ionizante , Poluentes Radioativos do Solo/efeitos adversos , Ucrânia , Trombose Venosa/etiologia , Trombose Venosa/patologiaRESUMO
OBJECTIVE: To establish which of hematological parameters have discriminatory ability for forecast the development of thromboses in spontaneous and radiation associated Ph negative myeloproliferative neoplasms (MPN). MATERIALS AND METHODS: It was analyzed hematological parameters of 85 patients with polycythemia vera (PV), 43 - essential thrombocythemia (ET) and 40 - primary myelofibrosis (PMF). The main group consisted of patients (PV = 18, ET = 6, PMF = 18) which were exposed to ionizing radiation due to the Chornobyl accident, and control - patients (PV = 67, ET = 37, PMF = 22) without affecting emergency radiation in history. RESULTS: It was determined, that in spontaneous PV predictive for the thromboses development value of the hema tocrit and the leukocytes is > 55 % and > 13.2 · 109/l respectively, and the total cholesterol is > 5.7 mmol/l. The effi ciency such factor as the "hematocrit > 55 %" (area under the curve - AUC = 0.67; p = 0.023) and the "leukocytes > 13.2 · 109/l "(AUC = 0.66; p = 0.011) is average for the predicting of thromboses, and the "total cholesterol > 5.7 mmol / l" (AUC = 0.92; p < 0.0001) is excellent. In radiation associated PV and spontaneous ET predictor of thromboses was the platelet count < 440.0 · 109/l and the leukocytes > 10.0 · 109/l respectively, and it character ized by very good (AUC = 0.84; p = 0.0002 and AUC = 0.72, p = 0.019, respectively) predictive power. In the main and in the control group of PV patients was determined the same AUC for application the "hematocrit> 55 %" (p = 0.800) and the "leukocytes > 13.2 · 109/l" (p = 0.831) in the thromboses prediction, but it was calculated dif ferent AUC for the "platelets < 440.0 · 109/l" (p = 0.0004). Therefore, the use such PB index as the "platelets < 440.0 · 109/l" for the thromboses risk assessment is appropriate only in PV patients with a history of radiation, the "hematocrit < 55 %", the "leukocytes < 13.2 · 109/l" - in the patients who suffered from the Chornobyl accident and in the persons affected by IR exclusively within the natural background radiation. In the main and in the control group of patients with ET is no difference between the AUC of the factor "leukocytes > 10.0 · 109 / l" (p = 0.509), so it can be used at spontaneous and radiation related ET.
