Ignjatovic Vera, Pelkmans Leonie, Kelchtermans Hilde, Al Dieri Raed, Hemker Coen, Kremers Romy, Bloemen Saartje, Karlaftis Vasiliki, Attard Chantal, de Laat Bas, Monagle Paul
Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
Synapse BV, CARIM, Maastricht University, Maastricht, Netherlands.
Thromb Res. 2015 Dec;136(6):1303-9. doi: 10.1016/j.thromres.2015.10.034. Epub 2015 Oct 26.
Infants and children have a lower incidence of thrombosis compared with adults. Yet, the mechanism of blood clot formation and structure in infants and children, as the end product of coagulation, has not been studied. This study aimed to establish differences in the mechanism of thrombin generation, fibrin clot formation and response to thrombolysis in infants and children compared with adults.
We studied thrombin generation, fibrin clot formation, structure and fibrinolysis in healthy infants, children and adults.
Younger populations had a decreased potential to generate thrombin, at a slower velocity compared with adults, correlating positively with age. Clot formation at venous shear rate was decreased in infants and children compared with adults, with increased time for fibrin formation, decreased fibrin formation velocity, resulting in decreased tendency for fibrin formation in younger populations. These differences were less pronounced at arterial shear rate. Studies of the fibrin clot structure in paediatric age groups showed a significantly larger pore size compared with adults, suggestive of a clot that is less resistant to fibrinolysis. The presence of tissue plasminogen activator (tPA) resulted in a significant decrease in the pore size of infants and children, but not in adults.
This is the first study to suggest that the mechanism of blood clot formation and nanostructure, as well as response to thrombolytic therapy is different in infants and children compared with adults.
与成人相比，婴幼儿血栓形成的发生率较低。然而，作为凝血终产物的婴幼儿血液凝块形成机制和结构尚未得到研究。本研究旨在确定婴幼儿与成人相比在凝血酶生成机制、纤维蛋白凝块形成及溶栓反应方面的差异。
我们研究了健康婴幼儿、儿童及成人的凝血酶生成、纤维蛋白凝块形成、结构及纤维蛋白溶解情况。
较年轻人群产生凝血酶的潜力降低，与成人相比速度较慢，且与年龄呈正相关。与成人相比，婴幼儿和儿童在静脉剪切速率下的凝块形成减少，纤维蛋白形成时间增加，纤维蛋白形成速度降低，导致较年轻人群中纤维蛋白形成趋势降低。这些差异在动脉剪切速率下不太明显。对儿科年龄组纤维蛋白凝块结构的研究表明，与成人相比，孔径明显更大，提示凝块对纤维蛋白溶解的抵抗力较低。组织型纤溶酶原激活剂（tPA）的存在导致婴幼儿和儿童的孔径显著减小，但对成人无此影响。
这是第一项表明婴幼儿与成人相比在血液凝块形成机制、纳米结构以及溶栓治疗反应方面存在差异的研究。
