Komai H, Juri M
Department of Cardiovascular Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan.
Int Angiol. 2009 Apr;28(2):138-43.
Aim of the study is to elucidate the prevalence and the prognosis of patients with peripheral arterial disease (PAD) who have reduced endogenous anti-coagulation protein activity.
Ninety six patients with PAD were studied, including 45 patients with intermittent claudication and 51 with critical limb ischemia. Among them 65 patients underwent peripheral artery bypass grafting. Venous blood samples were obtained and plasma activity level of Protein C (PC), Protein S (PS), Plasminogen (PLG), Antithrombin (AT) were measured. Based on the patients' clinical database the prevalence and clinical relevance was studied.
In our PAD patients PC activity is reduced in 18.8%, PS activity is reduced in 16.7%, PLG activity was reduced in 15.6% and AT activity was reduced in 24.0%. The incidence of AT activity deficiency was significantly higher in patients with critical limb ischemia than patients with claudication (P<0.01). After revascularization, arterial event free rate of patients with PC or PS activity deficiency and those with PLG deficiency were significantly lower than those without during the mean follow-up period of 26+/-31 months. The incidence of thromboembolic episodes and leg amputation rate were significantly worse in patients with PC deficiency.
PAD patients with reduced endogenous anti-coagulation proteins show worse prognosis than those without. Surgeons must be aware of it to improve the outcome of arterial revascularization.
本研究旨在阐明内源性抗凝蛋白活性降低的外周动脉疾病（PAD）患者的患病率及预后情况。
对96例PAD患者进行研究，其中45例为间歇性跛行患者，51例为严重肢体缺血患者。65例患者接受了外周动脉搭桥手术。采集静脉血样本，检测蛋白C（PC）、蛋白S（PS）、纤溶酶原（PLG）、抗凝血酶（AT）的血浆活性水平。基于患者临床数据库研究患病率及临床相关性。
在我们的PAD患者中，PC活性降低的占18.8%，PS活性降低的占16.7%，PLG活性降低的占15.6%，AT活性降低的占24.0%。严重肢体缺血患者的AT活性缺乏发生率显著高于间歇性跛行患者（P<0.01）。血运重建后，在平均26±31个月的随访期内，PC或PS活性缺乏患者以及PLG缺乏患者的无动脉事件发生率显著低于无这些缺乏情况的患者。PC缺乏患者的血栓栓塞发作发生率和截肢率显著更差。
内源性抗凝蛋白降低的PAD患者预后比未降低的患者更差。外科医生必须意识到这一点，以改善动脉血运重建的结果。
