Hematology and Hemoteraphy Center, University of Campinas, São Paulo, Brazil.
Thromb Res. 2012 Dec;130(6):889-93. doi: 10.1016/j.thromres.2012.09.009. Epub 2012 Sep 30.
Increased levels of inflammatory markers and clotting factors have been related to the pathogenesis and prognosis of venous thromboembolism. In particular, the imbalance between VWF and ADAMTS13 has been described in patients with arterial thrombosis. In this study, 77 patients with previous VTE and 77 matched controls were selected for the evaluation of the inflammatory markers, FVW, ADAMTS 13 and D-dimer. The presences of post-thrombotic syndrome and residual vein obstruction were also assessed in patients. Serum levels of TNF-α and IL-6 were significantly increased in patients compared to controls (median=2.25 vs 1.59 pg/mL, P ≤ 0.001; 1.16 vs 0.98 pg/ml, P=0.013, respectively). Plasma levels and activity of VWF (median=150.25 vs 95.39 U/dL, P ≤ 0.001; 145.26% vs 92.39%, P ≤ 0.001) and ADAMTS 13 (median=1088.84 vs 950.80 ng/mL, P ≤ 0.001; 96.03 vs 83.64%, P ≤ 0.001) were also higher in patients. We further analysed the subgroups of patients with higher risk for VTE recurrence or VTE sequelae, defined as the presence of high D-dimer levels, RVO or PTS. All inflammatory markers were significantly higher in patients with increased D-dimer. The presence of PTS or RVO was not associated with higher inflammatory or coagulation parameters. The increased levels of inflammatory markers and VWF may suggest that there is a persistence of inflammatory activity in patients even at long periods after the VTE episode. In this context, it may be postulated that increased levels of ADAMTS13 could represent a compensatory mechanism against persistently increased levels of VWF. Moreover, increased inflammatory activity was associated with increased D-dimer levels, thus it is possible that this inflammatory activity may also be related to the risk of VTE recurrence.
炎症标志物和凝血因子水平的升高与静脉血栓栓塞症的发病机制和预后有关。特别是，在动脉血栓形成患者中已经描述了 VWF 和 ADAMTS13 之间的失衡。在这项研究中，选择了 77 例先前患有 VTE 的患者和 77 例匹配的对照者，以评估炎症标志物、FVW、ADAMTS13 和 D-二聚体。还评估了患者的血栓后综合征和残留静脉阻塞的存在。与对照组相比，患者的 TNF-α和 IL-6 血清水平显着升高（中位数=2.25 对 1.59 pg/mL，P ≤ 0.001；1.16 对 0.98 pg/ml，P=0.013）。血浆水平和 VWF 活性（中位数=150.25 对 95.39 U/dL，P ≤ 0.001；145.26%对 92.39%，P ≤ 0.001）和 ADAMTS13（中位数=1088.84 对 950.80 ng/mL，P ≤ 0.001；96.03 对 83.64%，P ≤ 0.001）也在患者中更高。我们进一步分析了具有更高 VTE 复发或 VTE 后遗症风险的患者亚组，定义为高 D-二聚体水平、RVO 或 PTS 的存在。所有炎症标志物在 D-二聚体升高的患者中显着升高。PTS 或 RVO 的存在与更高的炎症或凝血参数无关。炎症标志物和 VWF 水平的升高可能表明即使在 VTE 发作后很长一段时间，患者仍存在炎症活动。在这种情况下，可以假设 ADAMTS13 水平的升高可能代表对持续升高的 VWF 水平的代偿机制。此外，炎症活性的增加与 D-二聚体水平的增加相关，因此可能认为这种炎症活性也与 VTE 复发的风险有关。
