Sakai H, Goto S, Kim J Y, Aoki N, Abe S, Ichikawa N, Yoshida M, Nagaoka Y, Handa S
Department of Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
Thromb Haemost. 2000 Aug;84(2):204-9.
Recent investigations have revealed the crucial role of von Willebrand factor (vWF) in platelet thrombus formation under flow conditions. The plasma concentrations of vWF were measured together with various hemodynamic and hemostatic parameters in 51 cases of acute myocardial infarction. In 10 randomly selected cases, the plasma concentrations and distribution of multimers vWF were serially determined after reperfusion therapy by percutaneous transluminal coronary angioplasty (PTCA). The vWF concentration at the onset of the acute myocardial infarction was significantly higher than in an age-matched control group (vWF AG: 18.7 +/- 1.2 microg/ml vs. 10.3 +/- 0.5 microg/ml, p = 8.43 x 10-(12), mean +/- SE). Simultaneous determination of hemodynamic and hemostatic parameters revealed that the only two parameters that were significantly correlated with the patients' plasma vWF concentrations were their pulmonary capillary wedge pressure (PCWP) and heart rate, suggesting a relationship between hemodynamic changes induced by the onset of myocardial infarction and the vWF plasma concentrations. Serial determinations revealed that the vWF concentrations had not changed 1 h after reperfusion therapy, but that they significantly increased by 24 to 72 h. The distribution of the larger multimers of vWF also increased in the acute and subacute phase. The vWF concentration and multimer distribution normalized 14 days after the onset of the myocardial infarction. Our findings suggest that the vWF concentration increased in acute myocardial infarction patients, possibly in association with the hemodynamic deterioration that occurs in acute myocardial infarction.
最近的研究揭示了血管性血友病因子（vWF）在血流条件下血小板血栓形成中的关键作用。在51例急性心肌梗死患者中，测量了vWF的血浆浓度以及各种血流动力学和止血参数。在10例随机选择的病例中，通过经皮腔内冠状动脉成形术（PTCA）进行再灌注治疗后，连续测定了vWF多聚体的血浆浓度和分布。急性心肌梗死发作时的vWF浓度显著高于年龄匹配的对照组（vWF AG：18.7±1.2μg/ml对10.3±0.5μg/ml，p = 8.43×10⁻¹²，平均值±标准误）。同时测定血流动力学和止血参数发现，与患者血浆vWF浓度显著相关的仅有的两个参数是肺毛细血管楔压（PCWP）和心率，这表明心肌梗死发作引起的血流动力学变化与vWF血浆浓度之间存在关联。连续测定显示，再灌注治疗1小时后vWF浓度未发生变化，但在24至72小时显著升高。vWF较大多聚体的分布在急性期和亚急性期也增加。心肌梗死发作14天后，vWF浓度和多聚体分布恢复正常。我们的研究结果表明，急性心肌梗死患者的vWF浓度升高，可能与急性心肌梗死时发生的血流动力学恶化有关。
