| Objective: To supervise the alteration of plasma ADAMTS13activity and VWF antigenlevel and to investigate their clinical significance in the recipients of hematopoieticstem-cell transplantation (HSCT).Methods:(1) Patients: We enrolled110patients (65males and45females) receiving HSCT fromOctober2011to October2012, and20healthy individuals (participants of blood donationprogram) in this study. The median age of the patients is33years (range4–57years), andthe median age of healthy individuals is31years (range22–54years). Of all the patientsrecruited for this study,8patients were diagnosed to have the thrombotic disorders,33patients were classified to have acute graft-versus-host disease (aGVHD),29patients hadinfection and40patients were stable.(2) Sample collection and detection: The sodium citrate anticoagulated plasma from110patients was collected in week-2,0,+2,+4following HSCT. FRETS-VWF73assay andELISA were used to detect the ADAMTS13activity and VWF antigen respectively.(3) Statistical analysis: Data was expressed as mean±standard deviation. Data differentwas analyzed using analysis of variance and t test. Rates were compared using chi-squaretest (X2). P<0.05was considered as significant difference. Logistic regression model wasused for analysis of correlation. Statistical software is SPSS17.0.Results:(1) ADAMTS13activity of4periods of recipients were lower than healthy control (P<0.01). ADAMTS13activity after pretreatment was significantly lower than before (P<0.05), and recovered gradually after hematopoietic reconstitution. Accordingly, VWF antigen level after transplantation were higher than the healthy control (P <0.05),especially after pretreatment (P <0.05). Among all the patients after pretreatment,72patients (65.45%) showed decreased plasma ADAMTS13activities.(2) Logistic regression analysis showed that the risk of ADAMTS13activity declination inpatients with conditioning regimen of TBI/CY increased (OR=6.5,95%CI:2.05-20.67,P<0.05). However, we found no significant correlation between these physiologicalresponses and the patients’ characteristics such as age, gender, disease and donor type(P>0.05).(3) Compared with the non-thrombotic patients,8patients with thrombotic complicationshad decreased plasma ADAMTS13activity and increased VWF antigen level afterpretreatment, especially for the patients having more than60%decrease in ADAMTS13activity. Conversely, VWF antigen level in patients with thrombotic complications hasalready at a high level before pretreatment.(4) During the observation periods, the minimum value of ADAMTS13activity in patientswith complications were lower than the stable group, and the lowest value (P <0.05)appeared in patients with thrombosis. The maximum value of VWF antigen level inpatients with complications were higher than the stable group, and the highest value (P<0.05) appeared in patients with thrombosis. Our experiment showed that the activity ofplasma ADAMTS13and VWF antigen level could be used as an important indicator ofearly diagnosis and treatment of thrombotic complications after transplantation.Conclusions:1. ADAMTS13activity of recipients were lower than healthy control, and decreasedsignificantly after pretreatment (P <0.05), while VWF antigen level increased (P <0.05).2. ADAMTS13activity in patients with thrombotic complications was lower than othersubgroups after pretreatment, and the percentage of declination by more than60werehigher. Logistic regression analysis showed that the ADAMTS13activity declined by morethan60%was the risk of thrombosis. VWF antigen level was at a high level in patientswith thrombosis. (3) During the observation periods, the minimum value of ADAMTS13activity in patientswith complications were lower than the stable group, and the lowest value (P <0.05)appeared in patients with thrombosis. The maximum value of VWF antigen level inpatients with complications were higher than the stable group, and the highest value (P<0.05) appeared in patients with thrombosis. |
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