Kreutz Rolf P, Owens Janelle, Breall Jeffrey A, Lu Deshun, von der Lohe Elisabeth, Bolad Islam, Sinha Anjan, Flockhart David A
Krannert Institute of Cardiology, Indiana University School of Medicine, 1800 N. Capitol Avenue, Indianapolis, IN 46202, USA.
Blood Coagul Fibrinolysis. 2013 Apr;24(3):321-6. doi: 10.1097/MBC.0b013e32835cc193.
Inflammation is implicated in the progression of coronary artery disease and the molecular processes of inflammation and thrombosis are closely intertwined. Elevated levels of C-reactive protein (CRP) have been associated with an elevated risk of adverse ischaemic events after coronary stenting and hypercoagulability. Heightened whole blood clot strength measured by thrombelastography (TEG) has been associated with adverse ischaemic events after stenting. We intended to examine the relationship of CRP to plasma fibrin clot strength in patients after coronary stenting. Plasma fibrin clot strength was measured by TEG in 54 patients 16-24 h after undergoing elective percutaneous coronary intervention (PCI). Coagulation was induced in citrated plasma by addition of kaolin and CaCl2. Plasma levels of CRP and fibrinogen were measured by enzyme-linked immunoassay. Increasing quartiles of CRP were associated with increasing levels of maximal plasma fibrin clot strength measured by TEG (P < 0.001) and increasing BMI (P = 0.04). Patients in the highest quartile of CRP had significantly higher maximal fibrin clot strength (G) than the patients in the lowest quartile (G: 3438 ± 623 vs. 2184 ± 576 dyn/cm, P < 0.0001). Fibrinogen concentration was not significantly different across quartiles of CRP (P = 0.97). Patients with established coronary artery disease undergoing coronary stenting who have elevated CRP after PCI exhibit heightened maximal plasma fibrin clot strength as compared with those with low CRP. Thrombotic risk associated with elevated CRP may be linked to procoagulant changes and high tensile fibrin clot strength independent of fibrinogen concentration.
炎症与冠状动脉疾病的进展有关，炎症和血栓形成的分子过程紧密相连。C反应蛋白（CRP）水平升高与冠状动脉支架置入术后不良缺血事件风险增加及高凝状态相关。通过血栓弹力图（TEG）测量的全血凝血强度升高与支架置入术后不良缺血事件相关。我们旨在研究冠状动脉支架置入术后患者CRP与血浆纤维蛋白凝块强度之间的关系。在54例接受择期经皮冠状动脉介入治疗（PCI）后16 - 24小时的患者中，通过TEG测量血浆纤维蛋白凝块强度。通过添加高岭土和氯化钙在枸橼酸盐血浆中诱导凝血。通过酶联免疫吸附测定法测量血浆CRP和纤维蛋白原水平。CRP四分位数增加与通过TEG测量的最大血浆纤维蛋白凝块强度增加相关（P < 0.001），且与体重指数增加相关（P = 0.04）。CRP最高四分位数的患者比最低四分位数的患者具有显著更高的最大纤维蛋白凝块强度（G）（G：3438±623 vs.2184±576 dyn/cm，P < 0.0001）。跨CRP四分位数的纤维蛋白原浓度无显著差异（P = 0.97）。与低CRP的患者相比，接受冠状动脉支架置入术且PCI后CRP升高的已确诊冠状动脉疾病患者表现出更高的最大血浆纤维蛋白凝块强度。与CRP升高相关的血栓形成风险可能与促凝变化和高拉伸纤维蛋白凝块强度有关而与纤维蛋白原浓度无关。
