Migdalski A, Jawien A, Kotschy M, Knapik-Bieniek A
Department of Surgery, L Rydygier Medical University, Bydgoszcz, Poland.
Eur J Vasc Endovasc Surg. 2004 Feb;27(2):172-9. doi: 10.1016/j.ejvs.2003.11.001.
To determine the concentration of selected haemostatic factors (HFs): thrombin-antithrombin complexes (TAT), antithrombin (AT), tissue plasminogen activator (t-PA), plasminogen activator inhibitor type 1 (PAI-1) and D-dimers in carotid bifurcation plaques and to compare plaque composition in different subgroups of patients (mainly those with symptomatic and asymptomatic carotid stenosis).
Thirty-eight consecutive patients (20 symptomatic, 18 asymptomatic) undergoing carotid endarterectomy were enrolled in the study. The concentration of selected HFs in carotid plaques was measured using mainly enzyme immunoassay (ELISA). Simultaneously, the concentration of HFs in plasma was also obtained.
Symptomatic plaques contained significantly more TAT complexes (p=0.03). AT was found only in nine out of 38 carotid plaques and was present mainly in symptomatic carotid plaques (n=8/9)(p<0.006). No significant differences were found between symptomatic and asymptomatic carotid plaques with respect to t-PA, PAI-1 and D-dimers concentration. There was an increased concentration of TAT (p<0.001), t-PA (p<0.02) and D-dimers (p<0.02) in carotid plaques of diabetic patients. Patients with coexisting intermittent claudication had elevated levels of D-dimers in carotid plaques (p<0.02). The only positive correlation was demonstrated between the concentration of AT in plasma and carotid plaques (R=0.76; p=0.02).
All the evaluated HFs are the components of a carotid plaque. Symptomatic patients have increased concentration of TAT complexes in a carotid plaque. The symptomatic carotid plaque contains AT more frequently, which correlates positively with AT plasma levels. The most marked changes in the carotid plaque haemostatic composition (expressed by elevated levels of TAT, t-PA and D-dimers) have diabetic patients.
测定颈动脉分叉处斑块中选定止血因子（HFs）的浓度：凝血酶 - 抗凝血酶复合物（TAT）、抗凝血酶（AT）、组织纤溶酶原激活物（t - PA）、纤溶酶原激活物抑制剂1型（PAI - 1）和D - 二聚体，并比较不同亚组患者（主要是有症状和无症状颈动脉狭窄患者）的斑块成分。
连续纳入38例行颈动脉内膜切除术的患者（20例有症状，18例无症状）。主要采用酶联免疫吸附测定（ELISA）法测定颈动脉斑块中选定HFs的浓度。同时，也获取了血浆中HFs的浓度。
有症状的斑块中TAT复合物含量显著更高（p = 0.03）。在38个颈动脉斑块中仅9个检测到AT，且主要存在于有症状的颈动脉斑块中（n = 8/9）（p < 0.006）。有症状和无症状颈动脉斑块在t - PA、PAI - 1和D - 二聚体浓度方面未发现显著差异。糖尿病患者颈动脉斑块中TAT（p < 0.001）、t - PA（p < 0.02）和D - 二聚体（p < 0.02）浓度升高。合并间歇性跛行的患者颈动脉斑块中D - 二聚体水平升高（p < 0.02）。血浆中AT浓度与颈动脉斑块之间仅显示出正相关（R = 0.76；p = 0.02）。
所有评估的HFs都是颈动脉斑块的组成成分。有症状患者颈动脉斑块中TAT复合物浓度升高。有症状的颈动脉斑块更频繁地含有AT，这与血浆中AT水平呈正相关。颈动脉斑块止血成分变化最明显的是糖尿病患者（以TAT、t - PA和D - 二聚体水平升高表示）。
