老年患者循环中的微颗粒和促凝活性。

Circulating microparticles and procoagulant activity in elderly patients.

机构信息

Geriatric center, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris, Université Pierre et Marie Curie-Paris 6, 47-83 boulevard de l'hôpital, 75651 Paris cedex 13, France.

出版信息

J Gerontol A Biol Sci Med Sci. 2010 Apr;65(4):414-20. doi: 10.1093/gerona/glp187. Epub 2009 Nov 25.

DOI:10.1093/gerona/glp187

PMID:19942591

Abstract

BACKGROUND

Microparticles (MP) are shed membrane vesicles released from activation or apoptosis of several cell types and carry a procoagulant activity. Age is associated with a procoagulant state, but the role of MP in this setting is unknown, as the relationship of MP to aging in humans. We tested the hypotheses that elderly persons compared with young persons may have different patterns of expression of MP and procoagulant activity in stable or septic conditions.

METHODS

Patients from Emergency and Geriatric Departments were divided into four groups according to their age (< 50 or > or = 75 years old) and the presence of systemic infection (yes or no). The diagnosis of infection was reached when it was classified as certain or possible by an expert panel. Circulating MP were isolated from venous citrated blood. Cytofluorometry using specific antibodies was performed to determine the origins of MP (endothelial microparticles [EMP], red blood cell microparticles, or platelet microparticles). Procoagulant activity was determined using annexin V (prothrombinase activity) and tissue factor (TF) assays.

RESULTS

One hundred and eleven patients were included. Elderly patients expressed a decrease in EMP in stable conditions, associated with a decrease in procoagulant annexin V MP in septic conditions (p < .05), and higher EMP levels were found in elderly infected patients who died during hospital stay than in survivors (p = .04). Compared with young patients, response to sepsis was altered in elders concerning EMP, annexin V MP, and TF-bearing MP.

CONCLUSION

Elderly patients expressed a different pattern of MP in stable conditions, with a different response to sepsis in procoagulant activity modification.

摘要

背景

微粒（MP）是从几种细胞类型的激活或凋亡中释放的膜囊泡，具有促凝活性。年龄与促凝状态有关，但 MP 在这种情况下的作用尚不清楚，因为 MP 与人类衰老的关系。我们检验了以下假设：与年轻人相比，老年人在稳定或感染性条件下可能具有不同的 MP 表达模式和促凝活性。

方法

根据年龄（<50 岁或≥75 岁）和是否存在全身感染（是或否），将来自急诊和老年科的患者分为四组。感染的诊断是通过专家组分类为明确或可能感染来确定的。用柠檬酸盐抗凝静脉血分离循环 MP。用特异性抗体进行细胞荧光术，以确定 MP 的来源（内皮微粒[EMP]、红细胞微粒或血小板微粒）。用 Annexin V（凝血酶原酶活性）和组织因子（TF）测定法测定促凝活性。

结果

共纳入 111 例患者。在稳定条件下，老年患者表达 EMP 减少，与感染性条件下促凝 Annexin V MP 减少相关（p<.05），在住院期间死亡的感染老年患者的 EMP 水平高于幸存者（p=0.04）。与年轻患者相比，老年人对 EMP、Annexin V MP 和 TF 载 MP 的反应在败血症方面发生了改变。