Ardissino D, Merlini P A, Bauer K A, Bramucci E, Ferrario M, Coppola R, Fetiveau R, Lucreziotti S, Rosenberg R D, Mannucci P M
Division of Cardiology, Ospedale Maggiore and University of Parma, Italy.
Blood. 2001 Nov 1;98(9):2726-9. doi: 10.1182/blood.v98.9.2726.
Higher levels of tissue factor (the initiator of blood coagulation) have been found in coronary atherosclerotic plaques of patients with unstable coronary artery disease, but it is not established whether they are associated with a different thrombotic response to in vivo plaque rupture. In 40 patients undergoing directional coronary atherectomy, prothrombin fragment 1 + 2, a marker of thrombin generation, was measured in intracoronary blood samples obtained proximally and distally to the coronary atherosclerotic plaque before and after the procedure. Before the procedure, plasma prothrombin fragment 1 + 2 levels were significantly increased across the lesion in patients with unstable, but not in those with stable, coronary disease (unstable, median increase, 0.37 nM; range, -0.35-1.16 nM) (stable, median increase, -0.065 nM; range, -0.58-1.06 nM) (P =.0021). After plaque removal, an increase in prothrombin fragment 1 + 2 across the lesion was observed only in patients with unstable coronary disease (unstable, median increase, 0.25 nM; range, -1.04-4.9 nM) (stable, 0.01 nM; range, -0.48-3.59 nM) (P =.036)]. There was a correlation between the tissue factor content of the plaque and the increase in thrombin generation across the lesion (rho = 0.33; P =.038). The higher tissue factor content found in plaques obtained from patients with unstable coronary disease was associated with a local increase in thrombin generation, thus suggesting a link with the in vivo thrombogenicity of the plaque.
在不稳定型冠状动脉疾病患者的冠状动脉粥样硬化斑块中发现了较高水平的组织因子（血液凝固的启动因子），但它们是否与体内斑块破裂时不同的血栓形成反应相关尚不确定。在40例行冠状动脉定向旋切术的患者中，在手术前后，分别从冠状动脉粥样硬化斑块近端和远端采集冠状动脉内血样，检测凝血酶生成标志物凝血酶原片段1 + 2。手术前，不稳定型冠心病患者病变部位血浆凝血酶原片段1 + 2水平显著升高，而稳定型冠心病患者则无此现象（不稳定型，中位数升高0.37 nM；范围，-0.35 - 1.16 nM）（稳定型，中位数升高-0.065 nM；范围，-0.58 - 1.06 nM）（P = 0.0021）。斑块切除后，仅在不稳定型冠心病患者中观察到病变部位凝血酶原片段1 + 2升高（不稳定型，中位数升高0.25 nM；范围，-1.04 - 4.9 nM）（稳定型，0.01 nM；范围，-0.48 - 3.59 nM）（P = 0.036）。斑块组织因子含量与病变部位凝血酶生成增加之间存在相关性（rho = 0.33；P = 0.038）。在不稳定型冠心病患者斑块中发现的较高组织因子含量与局部凝血酶生成增加相关，因此提示与斑块的体内血栓形成性有关。
