Choudhury Anirban, Chung Irene, Blann Andrew D, Lip Gregory Y H
Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK.
Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK.
Chest. 2007 Mar;131(3):809-815. doi: 10.1378/chest.06-2039.
Platelet microparticles (PMPs), are procoagulant membrane vesicles that are derived from activated platelets, the levels of which are elevated in patients with hypertension, coronary artery disease (CAD), diabetes, and stroke, all of which are conditions that lead to (and are associated with) atrial fibrillation (AF). We hypothesized the following: (1) PMP levels are elevated in patients with AF compared to levels in both healthy control subjects (ie, patients without cardiovascular diseases who are in sinus rhythm) and disease control subjects (ie, patients with hypertension, CAD, diabetes or stroke, but who are in sinus rhythm); (2) PMP levels correlate with levels of soluble P-selectin (sP-selectin) [a marker of platelet activation]; and (3) PMP levels are related to the underlying factors in patients with AF that contribute to the overall risk of stroke secondary to AF.
We performed a case-control study of 70 AF patients, 46 disease control subjects and 33 healthy control subjects. Peripheral venous levels of PMP and sP-selectin were analyzed by flow cytometry and enzyme-linked immunosorbent assay, respectively.
Both AF patients and disease control subjects had significantly higher levels of PMPs (p < 0.001) and sP-selectin (p = 0.001) compared to healthy control subjects, but there was no difference between AF patients and disease control subjects. There was no difference in PMP levels between patients with paroxysmal and permanent AF (p = 0.581), and between those receiving therapy with aspirin and warfarin (p = 0.779). No significant correlation was observed between PMP and sP-selectin levels (p = 0.463), and the clinical characteristics that contribute to increased stroke risk in patients with AF. On stepwise multiple regression analysis in the combined cohort of AF patients plus disease control subjects, the presence/absence of AF was not an independent determinant of PMP and sP-selectin levels.
There is evidence of platelet activation (ie, high PMP and sP-selectin levels) in AF patients, but this is likely to be due to underlying cardiovascular diseases rather than the arrhythmia per se.
血小板微粒（PMPs）是源自活化血小板的促凝膜泡，在高血压、冠状动脉疾病（CAD）、糖尿病和中风患者中其水平升高，而所有这些疾病均会导致（并与）心房颤动（AF）相关。我们做出如下假设：（1）与健康对照受试者（即无心血管疾病且处于窦性心律的患者）和疾病对照受试者（即患有高血压、CAD、糖尿病或中风但处于窦性心律的患者）相比，AF患者的PMP水平升高；（2）PMP水平与可溶性P选择素（sP选择素）[血小板活化标志物]水平相关；（3）PMP水平与AF患者中导致AF继发中风总体风险的潜在因素有关。
我们对70例AF患者、46例疾病对照受试者和33例健康对照受试者进行了病例对照研究。分别通过流式细胞术和酶联免疫吸附测定法分析PMP和sP选择素的外周静脉水平。
与健康对照受试者相比，AF患者和疾病对照受试者的PMPs（p < 0.001）和sP选择素（p = 0.001）水平均显著更高，但AF患者与疾病对照受试者之间无差异。阵发性AF与永久性AF患者之间的PMP水平无差异（p = 0.581），接受阿司匹林和华法林治疗的患者之间也无差异（p = 0.779）。未观察到PMP与sP选择素水平之间存在显著相关性（p = 0.463），以及与AF患者中风风险增加相关的临床特征之间存在显著相关性。在AF患者加疾病对照受试者的联合队列中进行逐步多元回归分析时，AF的存在与否并非PMP和sP选择素水平的独立决定因素。
有证据表明AF患者存在血小板活化（即高PMP和sP选择素水平），但这可能是由于潜在的心血管疾病而非心律失常本身所致。
