Kölbel Tilo, Strandberg Karin, Mattiasson Ingrid, Stenflo Johan, Lindblad Bengt
Department of Vascular Diseases, Malmö University Hospital, Malmö, Sweden.
J Vasc Surg. 2006 May;43(5):935-9. doi: 10.1016/j.jvs.2006.01.019.
The concentration of the complex between activated protein C (APC) and protein C inhibitor (PCI) is a measure of thrombin generation. We studied whether it can provide information useful for the diagnosis and treatment of arterial vascular disease.
Blood was obtained from 429 vascular patients admitted consecutively during September 2004 to March 2005. The APC-PCI complex was measured by using a sandwich immunofluorometric method. The patients were divided into cohorts according to the planned treatment and compared with a control group of healthy individuals.
The APC-PCI complex concentration varied from 0.08 to 2.50 microg/L. In the cohort of patients with aortic aneurysms (n = 78), the median APC-PCI value was 0.45 (10th to 90th percentile, 0.24-1.47), and values were clearly increased compared with all other cohorts (P < .0001). Patients with carotid disease (n = 73) yielded a median of 0.22 (10th to 90th percentile, 0.15-0.48). The median for claudicants (n = 74) was 0.26 microg/L (10th to 90th percentile, 0.15-0.75), which was higher than in those (n = 97) with critical ischemia (0.20; 10th to 90th percentile, 0.13-0.36; P < .0023). The cohort with other forms of atherosclerotic disease (n = 40) had a median of 0.23 (10th to 90th percentile, 0.14-0.42), whereas the value for a cohort of 21 patients with venous disease was 0.19 (10th to 90th percentile, 0.10-0.34). The median was 0.15 (10th to 90th percentile, 0.10-0.23) for the control group (n = 121).
Patients with atherosclerosis had an increased APC-PCI concentration that corresponded to increased generation of thrombin. Patients with aortic aneurysm had a threefold higher median concentration than the control group. We suggest that this remarkable increase is caused by the local activation of coagulation, and we surmise that APC-PCI measurements can be used as a screening tool to identify patients with aortic aneurysms.
活化蛋白C（APC）与蛋白C抑制剂（PCI）复合物的浓度是凝血酶生成的一个指标。我们研究了其是否能为动脉血管疾病的诊断和治疗提供有用信息。
采集了2004年9月至2005年3月期间连续收治的429例血管疾病患者的血液。采用夹心免疫荧光法检测APC-PCI复合物。根据计划治疗方案将患者分组，并与健康个体对照组进行比较。
APC-PCI复合物浓度在0.08至2.50微克/升之间。在主动脉瘤患者队列（n = 78）中，APC-PCI值中位数为0.45（第10至90百分位数，0.24 - 1.47），与所有其他队列相比明显升高（P <.0001）。颈动脉疾病患者（n = 73）的中位数为0.22（第10至90百分位数，0.15 - 0.48）。间歇性跛行患者（n = 74）的中位数为0.26微克/升（第10至90百分位数，0.15 - 0.75），高于严重缺血患者（n = 97）（0.20；第10至90百分位数，0.13 - 0.36；P <.0023）。其他形式动脉粥样硬化疾病患者队列（n = 40）的中位数为0.23（第10至90百分位数，0.14 - 0.42），而21例静脉疾病患者队列的值为0.19（第10至90百分位数，0.10 - 0.34）。对照组（n = 121）的中位数为0.15（第10至90百分位数，0.10 - 0.23）。
动脉粥样硬化患者的APC-PCI浓度升高，这与凝血酶生成增加相对应。主动脉瘤患者的中位数浓度比对照组高两倍。我们认为这种显著升高是由局部凝血激活引起的，并且推测APC-PCI测量可作为一种筛查工具来识别主动脉瘤患者。
