Chantarangkul Veena, Clerici Marigrazia, Bressi Caterina, Giesen Peter L A, Tripodi Armando
Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine, University and IRCCS Maggiore Hospital, Milano, Italy.
Haematologica. 2003 May;88(5):547-54.
The endogenous thrombin potential (ETP) represents the balance between pro- and anti-coagulant forces operating in plasma and can be used to investigate hyper- and hypo-coagulability. As a preliminary step to larger clinical studies we investigated the effect on ETP of phospholipids, tissue factor (TF) and residual platelets in frozen plasma.
We investigated platelet-poor and platelet-rich plasmas from healthy subjects, patients on oral anticoagulants (OA), or with hemophilia and women on oral contraceptives (OC), chosen as examples of the normal, hypo- and hyper-coagulable states in which ETP has been reported to be impaired.
Phospholipids had only a slight effect on ETP in all conditions except in women on OC, in whom the best diagnostic efficacy was observed at 0.5 microM. TF had only a slight effect in all conditions except hemophilia, in which an ETP impairment was observed only at low (1 pM) concentration. Residual platelets had considerable effects on ETP in frozen plasmas, but this was abrogated by filtration before freezing. ETP in platelet-rich plasma at 150x103/mm3 was similar to that obtained in filtered-plasma with 1.5 microM phospholipids in healthy subjects, patients on OA and patients with severe hemophilia, but not in those with mild- or moderate-hemophilia, where the ETP was higher in platelet-rich plasma.
The results suggest that the method can be used for investigations on the clinical value of ETP. Platelet-rich and platelet-poor plasma are suitable testing materials. The latter should be filtered before freezing to minimize the effect of residual platelets.
内源性凝血酶潜力（ETP）代表了血浆中促凝和抗凝力量之间的平衡，可用于研究高凝和低凝状态。作为更大规模临床研究的初步步骤，我们研究了冷冻血浆中磷脂、组织因子（TF）和残余血小板对ETP的影响。
我们研究了健康受试者、口服抗凝剂（OA）患者、血友病患者以及口服避孕药（OC）的女性的少血小板血浆和富血小板血浆，这些被选为据报道ETP受损的正常、低凝和高凝状态的示例。
除服用OC的女性外，磷脂在所有情况下对ETP的影响都很小，在服用OC的女性中，在0.5微摩尔浓度时观察到最佳诊断效果。TF在所有情况下的影响都很小，除了血友病患者，在血友病患者中仅在低（1皮摩尔）浓度下观察到ETP受损。残余血小板对冷冻血浆中的ETP有相当大的影响，但在冷冻前通过过滤可消除这种影响。在健康受试者、服用OA的患者和重度血友病患者中，150×10³/mm³的富血小板血浆中的ETP与含有1.5微摩尔磷脂的过滤血浆中的ETP相似，但在轻度或中度血友病患者中并非如此，在这些患者中富血小板血浆中的ETP更高。
结果表明该方法可用于研究ETP的临床价值。富血小板血浆和少血小板血浆是合适的检测材料。后者在冷冻前应进行过滤，以尽量减少残余血小板的影响。
