Dargaud Yesim, Trzeciak M Christine, Bordet Jean Claude, Ninet Jacques, Negrier Claude
Unite d'Hemostase Clinique- Laboratoire d'Hemostase, Hopital Edouard Herriot, Lyon, France.
Thromb Haemost. 2006 Nov;96(5):562-7.
There is currently no validated method to detect a prothrombotic phenotype. The question remains, can tissue factor (TF) induced thrombin generation (TG), as measured with the calibrated automated thrombinography (CAT) technique, according to Hemker et al., recognise a prothrombotic state either as such, or when the activated protein C (APC)-system is boosted with thrombomodulin (TM)? We determined the normal range of CAT-TG +/- TM in a group of 71 healthy blood donors, in 11 healthy women using oral contraceptives (OC), and in 89 patients with a history of venous thromboembolism (VTE), divided into a group of 50 in which a prothrombotic risk factor could be found (VTEprf+) and 39 others (VTEprf-). The endogenous thrombin potential (ETP) in the OC, VTEprf+ and VTEprf- group was significantly higher than for the controls. In the presence of TM, the differences were significantly higher than in its absence. The VTEprf+ group had a higher ETP, +/- TM than the VTEprf-group. In conclusion, TG, measured with the CAT technique in the presence of TM is capable of detecting the prothrombotic phenotype with a high sensitivity of 0.93 (95% confidence limits 0.82-0.99).
目前尚无经过验证的方法来检测血栓前状态。问题依然存在，根据Hemker等人的研究，使用校准自动凝血酶生成法（CAT）测量的组织因子（TF）诱导的凝血酶生成（TG），能否识别血栓前状态本身，或者当活化蛋白C（APC）系统通过血栓调节蛋白（TM）增强时？我们确定了71名健康献血者、11名使用口服避孕药（OC）的健康女性以及89名有静脉血栓栓塞（VTE）病史的患者（分为50名可发现血栓前危险因素的患者（VTEprf +）和39名其他患者（VTEprf -））的CAT - TG +/- TM正常范围。OC组、VTEprf +组和VTEprf -组的内源性凝血酶潜力（ETP）显著高于对照组。在存在TM的情况下，差异显著高于不存在TM时。VTEprf +组的ETP（+/- TM）高于VTEprf -组。总之，在存在TM的情况下用CAT技术测量的TG能够以0.93的高灵敏度（95%置信区间0.82 - 0.99）检测血栓前状态。
