Horne McDonald K, Merryman Paula K, Cullinane Ann M, Nghiem Khanh, Alexander H Richard
Department of Laboratory Medicine, W. G. Magnuson Clinical Center, Bethesda, Maryland, USA.
Am J Hematol. 2007 Sep;82(9):815-20. doi: 10.1002/ajh.20963.
We studied the blood coagulation system of 14 patients with metastatic malignancies before and after they had undergone major surgery. In addition to measuring a battery of coagulation factors, we assessed the function of the system with assays of whole blood thrombin generation. With the exceptions of factor VIII (fVIII), which increased, and fibrinogen and fIX, which did not change, the activities of all the pro- and anticoagulant proteins were significantly lower postoperatively. However, the thrombin generating capacity of the system was relatively preserved. Although the integral of thrombin activity over time was lower after surgery, the mean peak thrombin concentration was unchanged and the time to clot formation was shortened. Similar changes could be reproduced by lowering the concentrations of pro- and anticoagulant factors together in control blood samples. Therefore, simultaneous reductions in pro- and anticoagulant proteins postoperatively worked to maintain the functional integrity of the blood coagulation system.
我们研究了14例转移性恶性肿瘤患者在接受大手术前后的血液凝固系统。除了检测一系列凝血因子外，我们还通过全血凝血酶生成试验评估了该系统的功能。除了凝血因子VIII（fVIII）增加、纤维蛋白原和fIX未改变外，所有促凝和抗凝蛋白的活性在术后均显著降低。然而，该系统的凝血酶生成能力相对保持。虽然术后凝血酶活性随时间的积分较低，但平均凝血酶峰值浓度未改变，凝血形成时间缩短。通过在对照血样中同时降低促凝和抗凝因子的浓度，可以重现类似的变化。因此，术后促凝和抗凝蛋白的同时减少有助于维持血液凝固系统的功能完整性。
