间歇性气动压迫对稳定型跛行患者的影响：对止血和内皮功能的作用

Intermittent pneumatic compression in stable claudicants: effect on hemostasis and endothelial function.

作者信息

Sutkowska E, Wozniewski M, Gamian A, Gosk-Bierska I, Alexewicz P, Sutkowski K, Wysokinski W E

机构信息

Department of Physical Therapy and Rehabilitation, University School of Physical Education, Wroclaw, Poland.

出版信息

Int Angiol. 2009 Oct;28(5):373-9.

PMID:19935591

Abstract

AIM

Intermittent pneumatic compression (IPC) increases systemic fibrinolytic activity but may also injure endothelial cells and thereby induce coagulation. The safety and utility of IPC in patients with peripheral arterial disease (PAD) therefore remains uncertain. The aim of this study was to determine whether IPC is associated with coagulation activation and endothelial cell damage, platelet factor 4 (PF4), thrombin-antithrombin complex (TAT), total nitrate and nitrite level and von Willebrand factor (VWF) concentration.

METHODS

PF4, TAT, total nitrate, nitrite level and VWF were analyzed before and after first, 5th, 15th session (1 hour/day) of IPC and then 3 weeks after completion of therapy in 25 claudicants and compared to 11 healthy volunteers of similar age and sex.

RESULTS

PF4, a measure of platelet activation/secretion, was significantly higher in claudicants (55+/-50 IU/mL) compared to healthy controls (22+/-14 IU/mL) (P<0.05). In PAD patients PF4 has decreased steadily and significantly throughout the time of compressive therapy (to 33+/-42 IU/mL) and further more at the end of the follow-up period (23+/-26 IU/mL). TAT concentration was low in PAD patients but further decreased during IPC therapy. There was a tendency of nitrite and nitrate concentration to increase during the course of IPC therapy, but in PAD patients it did not reached statistical significance (P=0.2), while in healthy controls this increase was significant (up to 79+/-14 mmol/L, P<0.05) and persisted 3 weeks after completion of IPC (up to 82+/-7 mmol/L, P<0.05). VWF antigen concentration remained stable in claudicants during IPC therapy and 3 weeks later but significantly decreased during IPC therapy (after fifth and fifteenth IPC session, P=0.04) and stayed decreased 3 weeks after treatment termination in control group. Pain-free walking distance (PWD) had increased continuously during treatment period from 55+/-23 to 63+/-32 meters after fifth IPC treatment, to 81+/-43 (P<0.05) after the last session of therapy, and slightly decreased to 77+/-28 meters 3 weeks after completion of IPC.

CONCLUSIONS

IPC is safe for PAD patients, does not activate coagulation, but decreases platelet activation and improves endothelial health; this coincides with significant prolongation of walking distance.

摘要

目的

间歇性气动压迫（IPC）可提高全身纤溶活性，但也可能损伤内皮细胞，从而引发凝血。因此，IPC在周围动脉疾病（PAD）患者中的安全性和实用性仍不确定。本研究的目的是确定IPC是否与凝血激活、内皮细胞损伤、血小板因子4（PF4）、凝血酶 - 抗凝血酶复合物（TAT）、总硝酸盐和亚硝酸盐水平以及血管性血友病因子（VWF）浓度有关。

方法

对25名间歇性跛行患者在IPC治疗的第1次、第5次、第15次疗程（每天1小时）前后以及治疗完成后3周进行PF4、TAT、总硝酸盐、亚硝酸盐水平和VWF分析，并与11名年龄和性别相似的健康志愿者进行比较。

结果

作为血小板激活/分泌指标的PF4，间歇性跛行患者（55±50 IU/mL）显著高于健康对照组（22±14 IU/mL）（P<0.05）。在PAD患者中，PF4在整个压迫治疗期间持续且显著下降（至33±42 IU/mL），在随访期末进一步下降（至23±26 IU/mL）。PAD患者的TAT浓度较低，但在IPC治疗期间进一步下降。在IPC治疗过程中亚硝酸盐和硝酸盐浓度有升高趋势，但在PAD患者中未达到统计学意义（P = 0.2），而在健康对照组中这种升高具有显著性（高达79±14 mmol/L，P<0.05），并在IPC完成后3周持续存在（高达82±7 mmol/L，P<0.05）。在IPC治疗期间及3周后，间歇性跛行患者的VWF抗原浓度保持稳定，但在IPC治疗期间显著下降（在第5次和第15次IPC疗程后，P = 0.04），在对照组治疗终止后3周仍保持下降。在治疗期间，无痛步行距离（PWD）持续增加，从第5次IPC治疗后的55±23米增加到63±32米，在最后一次治疗后增加到81±43米（P<0.05），在IPC完成后3周略有下降至77±28米。