Herrera Ramón N, Díaz Elba, Pérez Aguilar Rossana, Bianchi Jorge, Berman Sofía, Luciardi Héctor L
Departamento de Hemostasia y Trombosis del Hospital Centro de Salud "Zenón J. Santillán", Facultad de Medicina, Universidad Nacional de Tucumán (UNT), Argentina.
Arch Cardiol Mex. 2005 Jul-Sep;75 Suppl 3:S3-38-48.
The aim of this study was to explore the presence of prothrombotic state in early stages of chronic Chagas' disease with serum markers of thrombosis and fibrinolysis, and to investigate it's association with thrombotic risk factors for venous thromboembolic disease.
Forty two patients with chronic Chagas' disease were compared with 21 healthy volunteers. Thrombotic markers used were fragment 1 + 2, ATM complex, fibrinogen/fibrin degradation products, D-dimer and beta-thromboglobulin. Fibrinolysis was evaluated with euglobulin lysis time, tissue plasminogen activator and it's inhibitor levels. A thrombophilic screening was performed. Antithrombin and protein C were determined by functional methods, as well as free fraction of protein S, resistance to activated protein C, factor V Leiden R506Q mutation, prothrombin G20210A mutation, homocysteine and antiphospholipid antibodies: lupus and anticardiolipin antibodies isoforms IgG and IgM.
In chronic Chagas' disease patients, statistically significant differences were observed in thrombotic markers: fragment 1 + 2 (p < 0.0001), ATM complex (p < 0.0001), fibrinogen/fibrin degradation products (p < 0.05) and D-dimer (p < 0.05). beta-thromboglobulin did not reach statistically significant difference (p = 0.06). Statistically significant differences (p < 0.0001) were found only in euglobulin lysis time, a non specific fibrinolytic marker. Specific fibrinolytic markers tissue plasminogen activator and it's inhibitor, however, did not show statistically significant differences among studied groups.
Eighty six percent of patients had positive thrombophilic screening for at least one thrombophilic risk factor. Thrombophilic risk factors were inherited in 39% and acquired in 83% of the patients.
本研究旨在通过血栓形成和纤维蛋白溶解的血清标志物，探讨慢性恰加斯病早期促血栓形成状态的存在情况，并研究其与静脉血栓栓塞性疾病血栓形成危险因素的关联。
将42例慢性恰加斯病患者与21名健康志愿者进行比较。使用的血栓形成标志物为1+2片段、ATM复合物、纤维蛋白原/纤维蛋白降解产物、D-二聚体和β-血小板球蛋白。通过优球蛋白溶解时间、组织纤溶酶原激活物及其抑制剂水平评估纤维蛋白溶解情况。进行了血栓形成倾向筛查。通过功能方法测定抗凝血酶和蛋白C，以及蛋白S的游离部分、对活化蛋白C的抵抗性、因子V莱顿R506Q突变、凝血酶原G20210A突变、同型半胱氨酸和抗磷脂抗体：狼疮和抗心磷脂抗体亚型IgG和IgM。
在慢性恰加斯病患者中，血栓形成标志物存在统计学显著差异：1+2片段（p<0.0001）、ATM复合物（p<0.0001）、纤维蛋白原/纤维蛋白降解产物（p<0.05）和D-二聚体（p<0.05）。β-血小板球蛋白未达到统计学显著差异（p=0.06）。仅在优球蛋白溶解时间这一非特异性纤维蛋白溶解标志物上发现统计学显著差异（p<0.0001）。然而，特异性纤维蛋白溶解标志物组织纤溶酶原激活物及其抑制剂在研究组之间未显示出统计学显著差异。
86%的患者至少有一项血栓形成倾向危险因素的筛查呈阳性。39%的患者血栓形成倾向危险因素为遗传性，83%为后天获得性。
