Heterozygosity for the Leiden mutation of the factor V gene, a common pathoetiology for osteonecrosis of the jaw, with thrombophilia augmented by exogenous estrogens

被引:48
作者
Glueck, CJ
Mcmahon, RE
Bouquot, JE
Triplett, D
Gruppo, R
Wang, P
机构
[1] CHILDRENS HOSP,MED CTR,DIV HEMATOL ONCOL,CINCINNATI,OH 45229
[2] INDIANA UNIV,MED CTR,RESIDUAL INFECT BONE PROJECT,INDIANAPOLIS,IN
[3] MAXILLOFACIAL CTR DIAGNOST & RES,MORGANTOWN,WV
来源
JOURNAL OF LABORATORY AND CLINICAL MEDICINE | 1997年 / 130卷 / 05期
基金
英国医学研究理事会;
关键词
D O I
10.1016/S0022-2143(97)90132-3
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
We assessed whether heterozygosity for the thrombophilic Leiden mutation of the factor V gene (MFV) was pathogenetic for alveolar osteonecrosis of the jaw and chronic facial pain (neuralgia-inducing cavitational osteonecrosis (NICO)) in 89 patients with NICO. A second specific aim was to assess for thrombophilic synergism between exogenous estrogens and MFV for development of osteonecrosis of the jaw. MFV was found in 24% of the patients, 16 (21%) of 76 women and 5 (39%) of 13 men. The mutation was much less common in healthy normal controls: 3 (3%) of 101 women (chi(2) = 14.8, p = 0.001) and 4 (3.7%) of 108 men (chi(2) = 20.4, p = 0.001). Patients with and without MFV did not differ in tissue plasminogen activator activity, plasminogen activator inhibitor activity, proteins C and S, lipoprotein (a), or anticardiolipin antibodies (p > 0.05). Use of standard-dose oral contraceptives and/or postmenopausal estrogens before the development of NICO was more common in female patients with MFV (13 (81%) of 16) than in those without it (23 (38%) of 60; chi(2) = 9.33, p = 0.002). When the thrombophilic effects of such exogenous estrogens were superimposed on the familial resistance to activated protein C associated with MFV, thrombophilia was augmented and the risk of osteonecrosis was increased. Since heterozygosity for this mutation occurs in at least 3% of unselected, healthy women, measurement of resistance to activated protein C and MFV would Identify women at high risk for venous thrombosis and osteonecrosis, in whom use of oral contraceptives or postmenopausal estrogens might be contraindicated, while identifying a much larger group of women (approximately 97%) without the mutation whose risk from exogenous estrogens would be low.
引用
收藏
页码:540 / 543
页数:4
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