With Notø Ann-Trude, Mathiesen Ellisiv Bøgeberg, Østerud Bjarne, Amiral Jean, Vissac Anne Marie, Hansen John-Bjarne
Center for Atherothrombotic Research in Tromsø, Institute of Clinical Medicine, University of Tromsø, Norway.
Thromb Haemost. 2008 Mar;99(3):602-8. doi: 10.1160/TH07-08-0493.
Echolucent carotid plaques are associated with higher risk for future ischemic cerebrovascular events (CVE) than echogenic plaques independent of the degree of stenosis. Elevated markers of thrombin generation are associated with atherosclerotic plaques and are increased in the acute and chronic phases of CVE. The present study was conducted to investigate the influence of plaque morphology on thrombin generation in persons with carotid stenosis. One hundred twenty-eight persons with carotid stenosis (>or=35% lumen diameter reduction) and 136 matched controls without stenosis were recruited from the health survey of the Tromsø Study. Blood samples were collected and plaque morphology determined by ultrasonography. Thrombin generation was assessed by thrombin-antithrombin complexes (TAT) and by prothrombin fragment 1+2 (F1+2). Persons with echogenic plaques (n = 63) had significantly higher levels of TAT (5.24 microg/l, 4.33-6.14) (mean, 95%CI) than persons with echolucent plaques (n = 65) (3.44 microg/l, 2.91-3.96, p < 0.001) and controls (n = 136) (3.33 microg/l, 3.06-3.60, p < 0.001). They also had significantly higher levels of F1+2 (2.14 nM, 1.83-2.45) than persons with echolucent plaques (1.54 nM, 1.38-1.71, p < 0.001) and controls (1.49 nM, 1.40-1.58, p < 0.001). TAT and F1+2 increased linearly with plaque echogenicity (p = 0.002 and p = 0.001, respectively) independent of the degree of stenosis. Increased thrombin generation was associated with a significant increase in plasma factor V levels among persons with echogenic plaques compared to echolucent plaques (p = 0.049) and controls (p = 0.025). The present findings indicate that increasing plaque echogenicity, rather than plaque echolucency and the degree of stenosis, is associated with thrombin generation in persons with carotid stenosis.
与强回声斑块相比，无论狭窄程度如何，无回声颈动脉斑块与未来缺血性脑血管事件（CVE）的风险更高相关。凝血酶生成的升高标志物与动脉粥样硬化斑块相关，并且在CVE的急性期和慢性期均增加。本研究旨在调查斑块形态对颈动脉狭窄患者凝血酶生成的影响。从特罗姆瑟研究的健康调查中招募了128例颈动脉狭窄（管腔直径减少≥35%）患者和136例匹配的无狭窄对照者。采集血样并通过超声检查确定斑块形态。通过凝血酶 - 抗凝血酶复合物（TAT）和凝血酶原片段1 + 2（F1 + 2）评估凝血酶生成。强回声斑块患者（n = 63）的TAT水平（5.24μg/l，4.33 - 6.14）（均值，95%CI）显著高于无回声斑块患者（n = 65）（3.44μg/l，2.91 - 3.96，p < 0.001）和对照者（n = 136）（3.33μg/l，3.06 - 3.60，p < 0.001）。他们的F1 + 2水平（2.14nM，1.83 - 2.45）也显著高于无回声斑块患者（1.54nM，1.38 - 1.71，p < 0.001）和对照者（1.49nM，1.40 - 1.58，p < 0.001）。TAT和F1 + 2与斑块回声性呈线性增加（分别为p = 0.002和p = 0.001），与狭窄程度无关。与无回声斑块患者相比，强回声斑块患者中凝血酶生成增加与血浆因子V水平显著升高相关（p = 0.049），与对照者相比也显著升高（p = 0.025）。目前的研究结果表明，在颈动脉狭窄患者中，斑块回声性增加而非斑块无回声性和狭窄程度与凝血酶生成相关。
