Okraska-Bylica Agnieszka, Wilkosz Tadeusz, Słowik Lidia, Bazanek Marta, Konieczyńska Małgorzata, Undas Anetta
Department of Diagnostics, John Paul II Hospital, Kraków, Poland.
Pol Arch Med Wewn. 2012;122(12):608-15. doi: 10.20452/pamw.1535. Epub 2012 Dec 11.
It has been shown that formation of denser and poorly lysable fibrin clots is observed in elderly patients with peripheral artery disease (PAD).
The aim of the study was to test the hypothesis that premature PAD is associated with more prothrombotic fibrin clot phenotype.
Ex‑vivo plasma fibrin clot permeability, turbidity, and susceptibility to lysis were evaluated in 31 premature PAD patients (median ankle brachial index [ABI], 0.75; interquartile range, 0.5-0.8) aged 55 or less and 32 PAD patients (ABI, 0.66; 0.56-0.76) aged over 55 years. Subjects without PAD matched for age and sex (n = 40) served as controls.
Premature PAD patients were characterized by 32% lower clot permeability (Ks) (P <0.001), 7% longer clot lysis time (t50%) (P = 0.004), and 31% higher maximum D-dimer levels released from fibrin clots (D-Dmax) (P <0.001) compared with controls. These differences remained significant after adjustment for risk factors and medications. None of the fibrin clot parameters differed between premature and older PAD patients. There were correlations between fibrin clot parameters and CRP in premature PAD patients and with ABI in older PAD patients. In a multiple regression model, premature PAD and ABI were independent predictors of Ks, and premature PAD and plasma fibrinogen of the maximum absorbance of a fibrin gel.
Plasma fibrin clots show similarly abnormal prothrombotic phenotype in premature and older PAD patients. However, different factors influence fibrin clot parameters in these patient groups. Premature PAD was an independent predictor of clot permeability and maximum absorbance of a fibrin gel.
研究表明，外周动脉疾病（PAD）老年患者会形成更致密且难溶解的纤维蛋白凝块。
本研究旨在验证过早发生PAD与更易形成血栓的纤维蛋白凝块表型相关这一假说。
对31名年龄55岁及以下的过早发生PAD患者（中位踝臂指数[ABI]为0.75；四分位间距为0.5 - 0.8）、32名年龄超过55岁的PAD患者（ABI为0.66；0.56 - 0.76）以及40名年龄和性别匹配的无PAD受试者作为对照，评估其体外血浆纤维蛋白凝块的通透性、浊度和溶解敏感性。
与对照组相比，过早发生PAD的患者凝块通透性（Ks）降低32%（P <0.001），凝块溶解时间（t50%）延长7%（P = 0.004），纤维蛋白凝块释放的最大D - 二聚体水平（D - Dmax）升高31%（P <0.001）。在对危险因素和药物进行调整后，这些差异仍然显著。过早发生PAD的患者与老年PAD患者之间的纤维蛋白凝块参数无差异。过早发生PAD的患者中，纤维蛋白凝块参数与CRP相关，老年PAD患者中则与ABI相关。在多元回归模型中，过早发生PAD和ABI是Ks的独立预测因素，过早发生PAD和血浆纤维蛋白原是纤维蛋白凝胶最大吸光度的独立预测因素。
过早发生PAD的患者和老年PAD患者的血浆纤维蛋白凝块均表现出类似的异常促血栓形成表型。然而，不同因素影响这些患者群体的纤维蛋白凝块参数。过早发生PAD是凝块通透性和纤维蛋白凝胶最大吸光度的独立预测因素。
