Rumley A, Emberson J R, Wannamethee S G, Lennon L, Whincup P H, Lowe G D O
Division of Cardiovascular and Medical Sciences, University of Glasgow, Royal Infirmary, 10 Alexandra Parade, Glasgow, UK.
J Thromb Haemost. 2006 May;4(5):982-7. doi: 10.1111/j.1538-7836.2006.01889.x.
Previous studies have suggested that several hemostatic and inflammatory variables, which are risk predictors for arterial or venous thrombosis, increase with age. However, there is a lack of data from large population studies for reliable estimates of reference ranges.
To establish reliable reference ranges of hemostatic and inflammatory variables for 5-year age groups in older men and their implications for pathogenesis and diagnosis.
A total of 3861 men aged 60-79 years at the 20 years follow-up of the British Regional Heart Study.
Several variables increased with age. The greatest median increases between 60-64 and 75-79 years age groups were observed for fibrin D-dimer (91%) and C-reactive protein (CRP) (57%). Significant median increases were also observed for von Willebrand factor antigen (23%), tissue plasminogen activator antigen (11%), factor VIII (10%), and fibrinogen (8%). In contrast, levels of classical cardiovascular risk factors neither decreased nor increased substantially with age, with the exception of systolic blood pressure (median increase 10%).
The exponential increases in risk of arterial and venous thrombotic events in men between age 60 and 79 years (when most such events occur) may be related in part to increasing activation of blood coagulation, fibrinolysis, and inflammation; possibly related to the increasing inflammatory burden of both atherosclerotic and non-vascular disease. These increases also have implications for diagnosis of suspected acute venous thromboembolism (D-dimer), and recently proposed screening for prediction of coronary heart disease risk and detection of occult disease (CRP).
既往研究表明，动脉或静脉血栓形成的风险预测指标——多项止血和炎症变量会随年龄增长而升高。然而，大型人群研究缺乏数据以可靠估计参考范围。
建立老年男性5岁年龄组止血和炎症变量的可靠参考范围及其对发病机制和诊断的意义。
在英国地区心脏研究20年随访中纳入了3861名年龄在60 - 79岁的男性。
多个变量随年龄增长而升高。在60 - 64岁和75 - 79岁年龄组之间，纤维蛋白D - 二聚体（91%）和C反应蛋白（CRP）（57%）的中位数升高幅度最大。血管性血友病因子抗原（23%）、组织纤溶酶原激活物抗原（11%）、因子VIII（10%）和纤维蛋白原（8%）也有显著的中位数升高。相比之下，经典心血管危险因素水平除收缩压（中位数升高10%）外，并未随年龄显著降低或升高。
60至79岁男性（大多数此类事件发生于此年龄段）发生动脉和静脉血栓事件的风险呈指数级增加，这可能部分与凝血、纤溶和炎症激活增加有关；可能与动脉粥样硬化和非血管疾病的炎症负担增加有关。这些升高对疑似急性静脉血栓栓塞症（D - 二聚体）的诊断以及最近提出的冠心病风险预测和隐匿性疾病检测（CRP）筛查也有影响。
