Smith A, Quarmby J W, Collins M, Lockhart S M, Burnand K G
Dept. of Surgery, UMDS, St Thomas' Hospital, London, UK.
Thromb Haemost. 1999 Dec;82(6):1593-9.
Current biochemical markers of thrombosis, such as d-dimer, are of little value in demonstrating the presence of thrombus postoperatively, as their levels are elevated by surgery. Thrombosis involves adhesive interactions between the endothelium, platelets and leukocytes. The aim of the study was to determine which of a panel of haemostatic and adhesion factors are altered by the presence of thrombus, but not by surgery. These factors were measured in 20 patients with established spontaneous DVTs, 13 patients having hip replacement surgery and 28 control patients. Circulating levels of P-selectin, VCAM-1 and tissue factor were found to be increased when thrombus was present (p <0.018, p <0.0001, p <0.0028 respectively), but were not altered by surgery. The significance of these circulating factors in venous thrombosis remains to be established, but it is conceivable that they are the product of increased leukocyte trafficking and activity. Assay of VCAM-1, in particular, may be of use in the early detection of venous thrombi in postoperative patients.
当前的血栓形成生化标志物，如D - 二聚体，在证明术后血栓存在方面价值不大，因为手术会使其水平升高。血栓形成涉及内皮、血小板和白细胞之间的黏附相互作用。本研究的目的是确定一组止血和黏附因子中哪些会因血栓存在而改变，但不受手术影响。对20例确诊为自发性深静脉血栓形成的患者、13例接受髋关节置换手术的患者和28例对照患者进行了这些因子的检测。发现血栓存在时，P - 选择素、血管细胞黏附分子 - 1（VCAM - 1）和组织因子的循环水平升高（分别为p <0.018、p <0.0001、p <0.0028），但不受手术影响。这些循环因子在静脉血栓形成中的意义尚待确定，但可以想象它们是白细胞运输和活性增加的产物。特别是，VCAM - 1检测可能有助于术后患者静脉血栓的早期检测。
