Park Jong Kwon, Bae Dong Sik, Kim Yong Han, Shin Kyong Jin
Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea.
Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea.
Ann Vasc Surg. 2015 Feb;29(2):227-36. doi: 10.1016/j.avsg.2014.07.033. Epub 2014 Oct 5.
Aging is associated with changes in coagulation status and progression of arterial insufficiency. The purpose of this study was to identify interrelationships among aging, coagulation status, and leg necrosis in patients with critical limb ischemia (CLI).
Between March 2010 and February 2013, 103 consecutive patients with CLI were enrolled in this study. Retrospective analyses were performed on patient characteristics including age, gender, the presence or the absence of leg necrosis, diabetes mellitus (DM), hypertension, and smoking, and preoperatively measured baseline coagulability factors, which included measurements of coagulation factors anticardiolipin antibodies IgG and IgM, lupus anticoagulant and factor 8, the fibrinolytic factor tissue plasminogen activator (t-PA), and natural anticoagulants proteins C and S and antithrombin III.
Among 103 patients with CLI, a total of 49 legs from 41 patients presented varying degrees of necrosis. CLI patients with DM and hypertension showed significantly increased incidences of leg necrosis compared with those without (P = 0.000, 0.039, respectively). Patients with CLI and leg necrosis were significantly older compared with the age of those without necrosis (P = 0.007). Blood levels of anticardiolipin antibodies IgG and IgM, factor 8, lupus anticoagulant, and t-PA tended to increase with age. However, blood levels of proteins C and S and antithrombin III decreased with patient age. Patients with CLI and leg necrosis showed significantly increased levels of lupus anticoagulant (P = 0.049) and significantly decreased levels of proteins C and S (P = 0.009 and 0.018, respectively) compared with patients without leg necrosis.
Patients with CLI and leg necrosis were significantly older compared with those without necrosis; similarly, our results revealed age-related hypercoagulability, with significantly elevated coagulation factor lupus anticoagulant and decreased natural anticoagulants protein C and S levels. From these observations, we conclude that age-related hypercoagulability may be an important mechanism that may facilitate leg necrosis in patients with CLI.
衰老与凝血状态的改变以及动脉供血不足的进展相关。本研究的目的是确定严重肢体缺血（CLI）患者衰老、凝血状态和腿部坏死之间的相互关系。
在2010年3月至2013年2月期间，103例连续的CLI患者纳入本研究。对患者特征进行回顾性分析，包括年龄、性别、有无腿部坏死、糖尿病（DM）、高血压和吸烟情况，以及术前测量的基线凝血因子，其中包括凝血因子抗心磷脂抗体IgG和IgM、狼疮抗凝物和因子8、纤溶因子组织型纤溶酶原激活剂（t-PA），以及天然抗凝蛋白C和S和抗凝血酶III。
在103例CLI患者中，41例患者的49条腿出现了不同程度的坏死。与无DM和高血压的CLI患者相比，合并DM和高血压的CLI患者腿部坏死发生率显著增加（分别为P = 0.000和0.039）。与无坏死的患者相比，有CLI和腿部坏死的患者年龄显著更大（P = 0.007）。抗心磷脂抗体IgG和IgM、因子8、狼疮抗凝物和t-PA的血液水平随年龄增长有升高趋势。然而，蛋白C和S以及抗凝血酶III的血液水平随患者年龄增长而降低。与无腿部坏死的患者相比，有CLI和腿部坏死的患者狼疮抗凝物水平显著升高（P = 0.049），蛋白C和S水平显著降低（分别为P = 0.009和0.018）。
与无坏死的患者相比，有CLI和腿部坏死的患者年龄显著更大；同样，我们的结果显示与年龄相关的高凝状态，凝血因子狼疮抗凝物显著升高，天然抗凝蛋白C和S水平降低。从这些观察结果来看，我们得出结论，与年龄相关的高凝状态可能是促进CLI患者腿部坏死的一个重要机制。
