癌症相关血栓性微血管病:文献综述和五例病例报告

Life Pub Date : 2024-07-10 DOI:10.3390/life14070865
L. Posado-Domínguez, Antonio-J Chamorro, E. Del Barco-Morillo, M. Martín-Galache, D. Bueno-Sacristán, E. Fonseca-Sánchez, A. Olivares-Hernández
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摘要

血栓性微血管病(TMA)是一种由内皮功能障碍介导的解剖病理病变,其特点是在小血管中产生微血栓。在癌症患者中,可能是由于化疗、肿瘤栓塞或造血祖细胞移植引起的继发性毒性。癌症相关 TMA 是一种被低估的疾病,通常出现在疾病的最后阶段,但也可能是潜在癌症的最初表现。在所有病例中,支持治疗都是必要的,根据病因,可采用不同的靶向疗法。预后很差。在本文中,我们将对现有文献中有关癌症相关 TMA 生理机制的内容进行全面综述。随后,我们将介绍五例于 2023 年在我科确诊的 TMA 患者的临床病例。我们将讨论引发该病症的不同原因、低估该病症的可能原因以及可采取的措施。
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Cancer-Associated Thrombotic Microangiopathy: Literature Review and Report of Five Cases
Thrombotic microangiopathy (TMA) is an anatomopathological lesion mediated by endothelial dysfunction and characterized by the creation of microthrombi in small vessels. In patients with cancer, it may be due to toxicity secondary to chemotherapy, tumor embolization, or hematopoietic progenitor transplantation. Cancer-associated TMA is an underestimated entity that generally appears in the final stages of the disease, although it may also be the initial manifestation of an underlying cancer. Support treatment is necessary in all cases and, depending on the cause, different targeted therapies may be used. The prognosis is very poor. In this article we present a comprehensive review of the existing literature on the physiological mechanisms of cancer-associated TMA. Afterwards, five clinical cases will be presented of patients who developed TMA and were diagnosed in our Department in 2023. We present a discussion of the different causes that triggered the condition, the possible reasons behind the underestimation of this pathology, and the measures that may be adopted.
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