Gill Heart Institute, University of Kentucky, 326 Charles T Wethington Building, 900 South Limestone, Lexington, KY 40536-0293, USA.
J Thromb Thrombolysis. 2011 Feb;31(2):139-45. doi: 10.1007/s11239-010-0513-1.
Bleeding events have been associated with adverse early and late outcomes in virtually all clinical settings. The mechanism behind this observation remains poorly understood. We sought to determine if the reason might be the provocation of an inflammatory response by bleeding events. In a formal substudy of the ACUITY trial, plasma samples of a range of biomarkers were collected at baseline, discharge, 30 days, and 1 year from 192 patients with acute coronary syndromes (ACS) and were analyzed in a central core laboratory. Temporal changes in biomarker levels were assessed in patients who experienced in-hospital hemorrhagic events, recurrent ischemic events, or neither. Sixteen patients were excluded from the study (7 with incomplete samples, 5 undergoing coronary artery bypass grafting (CABG) during index hospitalization; 1 had both bleeding and ischemic events). Median high sensitivity C-reactive protein (hs-CRP) levels (mg/l) increased significantly more from admission to discharge among the 9 patients who experienced an in-hospital major bleed compared to either the 9 patients who had a recurrent ischemic event (+6.0 vs. +0.70, P = 0.04) or the 151 patients who had no event (+6.0 vs. +0.60, P = 0.003). Compared to patients with no in-hospital events, median interleukin-6 (IL-6) levels (pg/ml) increased from admission to hospital discharge non-significantly in those with a bleeding event (+0.92 vs. +2.46, P = 0.55) and in those who experienced an in-hospital recurrent ischemic event (+0.92 vs. +3.60, P = 0.09). These data suggest that major bleeding is associated with development of a pro-inflammatory state. If confirmed, this mechanism may in part explain the poor prognosis of patients experiencing an acute hemorrhagic event.
几乎所有临床环境中的出血事件都与不良的早期和晚期结局相关。但这一观察结果背后的机制仍未得到充分理解。我们试图确定原因是否可能是出血事件引发了炎症反应。在 ACUITY 试验的一项正式子研究中，192 名急性冠脉综合征（ACS）患者在基线、出院时、30 天时和 1 年时采集了一系列生物标志物的血浆样本，并在中央核心实验室进行了分析。在经历院内出血事件、复发性缺血事件或两者都没有的患者中，评估了生物标志物水平的时间变化。16 名患者被排除在研究之外（7 名患者样本不完整，5 名患者在住院期间接受了冠状动脉旁路移植术（CABG）；1 名患者同时发生了出血和缺血事件）。与复发性缺血事件患者（+6.0 比+0.70，P = 0.04）或无事件患者（+6.0 比+0.60，P = 0.003）相比，在经历院内大出血的 9 名患者中，从入院到出院，高敏 C 反应蛋白（hs-CRP）水平（mg/L）的中位数显著增加（+6.0 比+0.70，P = 0.04）。与无院内事件的患者相比，在发生出血事件的患者中，白细胞介素-6（IL-6）水平（pg/ml）从入院到出院时非显著增加（+0.92 比+2.46，P = 0.55），而在经历院内复发性缺血事件的患者中也非显著增加（+0.92 比+3.60，P = 0.09）。这些数据表明，大出血与炎症状态的发展有关。如果得到证实，这种机制可能部分解释了经历急性出血事件的患者预后不良的原因。
