Kleinegris Marie-Claire, Ten Cate-Hoek Arina J, Ten Cate Hugo
Laboratory for Clinical Thrombosis and Hemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands. m‑
Pol Arch Med Wewn. 2012;122(11):557-66. doi: 10.20452/pamw.1464. Epub 2012 Nov 15.
The blood coagulation system is a key survival mechanism that has developed to protect man against lethal bleeding. A second function of blood coagulation is its close interaction with immunity. The immune-mediated coagulation responses may broadly be regarded as an element of response to injury. Pathological coagulation responses, including thromboembolism and disseminated intravascular coagulation (DIC), could therefore be regarded as excessive immune responses to a vessel wall injury. Virchow's triad, which comprises changes in the components of the blood, the state of the vessel wall, and the blood flow, was originally proposed for venous thrombosis. However, lately it appears that the same principles can be applied to arterial thrombosis and even DIC. It has even been postulated that all forms of thrombosis may be part of a continuous spectrum of the same disease. Over the past few years, an accumulation of evidence has shown that the etiopathogenetic mechanisms behind venous and arterial thrombosis are quite similar. The traditional elements of Virchow's triad are found to apply to both arterial and venous thrombosis. Yet, nowadays more emphasis is placed on the vessel wall and vascular bed specificity and the interaction with inflammation and hypercoagulability. This narrative review will discuss recent advances in research on the possible interactions between coagulation, the vascular endothelium, and atherosclerosis as well as the consequences of such interactions for venous and arterial thrombosis.
血液凝固系统是一种关键的生存机制，其进化是为了保护人类免受致命性出血。血液凝固的第二个功能是它与免疫的密切相互作用。免疫介导的凝血反应大致可被视为对损伤的一种反应要素。因此，包括血栓栓塞和弥散性血管内凝血（DIC）在内的病理性凝血反应可被视为对血管壁损伤的过度免疫反应。由血液成分、血管壁状态和血流变化组成的维勒三联征最初是针对静脉血栓形成提出的。然而，最近似乎同样的原理也可应用于动脉血栓形成甚至DIC。甚至有人推测，所有形式的血栓形成可能都是同一种疾病连续谱的一部分。在过去几年中，越来越多的证据表明，静脉和动脉血栓形成背后的病因发病机制非常相似。维勒三联征的传统要素被发现适用于动脉和静脉血栓形成。然而，如今更强调血管壁和血管床的特异性以及与炎症和高凝状态的相互作用。这篇叙述性综述将讨论凝血、血管内皮和动脉粥样硬化之间可能的相互作用的研究最新进展，以及这种相互作用对静脉和动脉血栓形成的影响。
