Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
J Infect. 2015 Apr;70(4):324-34. doi: 10.1016/j.jinf.2014.10.006. Epub 2014 Oct 29.
Human tuberculosis (TB) remains an important cause of death globally. Bangladesh is one of the most affected countries. We aimed to investigate the impact of pulmonary TB on pro- and anticoagulant mechanisms.
This prospective study was conducted in Chittagong, Bangladesh. We performed an in-depth analysis of coagulation activation and inhibition in plasma obtained from 64 patients with primary lung TB and 11 patients with recurrent lung TB and compared these with 37 healthy controls. Additionally, in nine patients coagulation activation was studied in bronchoalveolar lavage fluid (BALF) harvested from the site of infection and compared with BALF from a contralateral unaffected lung subsegment.
Relative to uninfected controls, primary and recurrent TB were associated with a systemic net procoagulant state, as indicated by enhanced activation of coagulation (elevated plasma levels of thrombin-antithrombin complexes, D-dimer and fibrinogen) together with impaired anticoagulant mechanisms (reduced plasma levels of antithrombin, protein C activity, free protein S, and protein C inhibitor). Activation of coagulation did not correlate with plasma concentrations of established TB biomarkers. Coagulation activation could not be detected at the primary site of infection in a subset of TB patients.
Pulmonary TB is associated with a systemic hypercoagulable state.
人类结核病（TB）仍然是全球范围内的一个重要死亡原因。孟加拉国是受影响最严重的国家之一。我们旨在研究肺结核对促凝和抗凝机制的影响。
本前瞻性研究在孟加拉国吉大港进行。我们对 64 例原发性肺结核患者和 11 例复发性肺结核患者的血浆中的凝血激活和抑制进行了深入分析，并将其与 37 名健康对照者进行了比较。此外，在 9 例患者中，研究了从感染部位采集的支气管肺泡灌洗液（BALF）中的凝血激活情况，并与对侧未受影响的肺亚段的 BALF 进行了比较。
与未感染对照者相比，原发性和复发性 TB 与全身性净促凝状态相关，表现为凝血激活增强（凝血酶-抗凝血酶复合物、D-二聚体和纤维蛋白原的血浆水平升高），同时抗凝机制受损（抗凝血酶、蛋白 C 活性、游离蛋白 S 和蛋白 C 抑制剂的血浆水平降低）。凝血激活与已建立的 TB 生物标志物的血浆浓度无关。在一部分 TB 患者中，在感染的原发性部位无法检测到凝血激活。
肺结核与全身性高凝状态有关。
