Department of Respiratory Medicine, University Hospital Llandough, Penarth, CF64 2XX, Wales.
Chest. 2010 Jul;138(1):47-51. doi: 10.1378/chest.09-2764. Epub 2010 Feb 12.
It has been demonstrated that there is an increased risk of venous thromboembolism (VTE) during air travel on flights of long duration. Patients with COPD are also at increased risk of VTE, particularly during exacerbations, possibly because of a hypercoagulable state secondary to hypoxia and/or heightened systemic inflammation. We investigated the effects of hypoxia on indices of coagulation and systemic inflammation in patients with COPD.
Twenty clinically stable patients with mild COPD were recruited. Patients were randomized to receive either medical air or 100% nitrogen through a 40% venturi mask at a flow rate of 10 L/min for 2 h. Blood was sampled for thrombin-antithrombin complex (TAT), prothrombin activation fragments 1 + 2 (F(1 + 2)), von Willebrand factor antigen (VWF:Ag), D-dimer, and interleukin-6 (IL-6) at baseline and after 2 h.
Patients in the hypoxia and control groups were similar in terms of age, sex, pack-years smoked, and severity of airflow obstruction. There was no difference in baseline TAT, F(1 + 2), VWF:Ag, D-dimer, or IL-6 levels between groups. In the control group, there was no change in markers of coagulation or systemic inflammation over the 2-h study. In patients who underwent hypoxic challenge, there was an increase in TAT (P < .001), F(1 + 2) (P < .01), and IL-6 (P < .01), whereas D-dimer and VWF:Ag levels were unchanged.
This study demonstrates that a 2-h hypoxic challenge in patients with COPD results in coagulation activation in conjunction with an increase in systemic inflammation.
已经证实，长时间飞行中的航空旅行会增加静脉血栓栓塞症（VTE）的风险。COPD 患者也有更高的 VTE 风险，尤其是在加重期，这可能是由于缺氧和/或全身炎症反应引起的高凝状态所致。我们研究了缺氧对 COPD 患者凝血和全身炎症指标的影响。
招募了 20 名临床稳定的轻度 COPD 患者。患者随机接受医用空气或通过 40%文丘里面罩以 10 L/min 的流速输送的 100%氮气，持续 2 小时。在基线和 2 小时后采集血液样本，用于检测凝血酶抗凝血酶复合物（TAT）、凝血酶原激活片段 1+2（F(1+2)）、血管性血友病因子抗原（VWF：Ag）、D-二聚体和白细胞介素-6（IL-6）。
在年龄、性别、吸烟包年数和气流阻塞严重程度方面，缺氧组和对照组患者相似。两组的基线 TAT、F(1+2)、VWF：Ag、D-二聚体或 IL-6 水平无差异。在对照组中，凝血和全身炎症标志物在 2 小时的研究中没有变化。在接受缺氧挑战的患者中，TAT（P<0.001）、F(1+2)（P<0.01）和 IL-6（P<0.01）增加，而 D-二聚体和 VWF：Ag 水平不变。
这项研究表明，COPD 患者 2 小时的缺氧挑战会导致凝血激活，并伴有全身炎症反应增加。
