健康受试者体内天然抗凝剂水平升高的决定因素。

Determinants of Elevated Levels of Natural Anticoagulants in Healthy Subjects.

作者信息

Kościelniak Barbara, Wypasek Ewa, Undas Anetta

机构信息

John Paul II Hospital, Kraków, Poland.

Institute of Cardiology, John Paul II Hospital, Jagiellonian University Medical College, Kraków, Poland.

出版信息

Adv Clin Exp Med. 2015 Sep-Oct;24(5):791-800. doi: 10.17219/acem/44361.

DOI:10.17219/acem/44361

PMID:26768629

Abstract

BACKGROUND

The levels of protein C (PC), free protein S (PS) and antithrombin (AT) are evaluated during thrombophilia screening to exclude their deficiencies.

OBJECTIVES

The aim of this study was to investigate factors which determine the elevated levels of natural plasma anticoagulants in healthy individuals.

MATERIAL AND METHODS

The PC activity and antigen, free PS antigen and AT activity together with hematological, biochemical, genetic and immunological laboratory tests were assessed in 130 healthy adults (63 males) aged 20-60 (median 41) years. Individuals with personal or family history of cardiovascular diseases and venous thromboembolism were ineligible.

RESULTS

The functionally active PC measured by chromogenic assay (values above 140%) was observed in 14 (11%) of subjects, while the PC antigen determined using the enzyme-linked immunosorbent assay (ELISA) was elevated in 5 (4%) of these patients. Free PS measured by immunoturbidimetry and ELISA was increased in 9 (7%) subjects (values above 139% in men and 114% for women) and in 6 (5%) patients (values above 130% in men and 111% for women), respectively. The AT activity above 118% was found in 5 (4%) subjects measured using chromogenic assay. None of the individuals had any deficiency of natural anticoagulants. Increased C-reactive protein (CRP)>3.0 mg/L was associated with elevated PC activity (odd ratio [OR]: 11.14, 95% confidence interval [CI] 1.67-74.23). Increased free PS assessed by immunoturbidimetric assay and PC activity were associated with hypercholesterolemia (OR: 3.57, 95% CI: 1.09-10.06 and OR: 8.61, 95% CI: 1.07-69.04, respectively). Body mass index≥25 kg/m2 was independently associated with elevated PC activity (OR: 3.42, 95% CI: 1.01-11.52). No risk factors for elevated AT activity were identified.

CONCLUSIONS

Apart from hypercholesterolemia and overweight, increased serum CRP is associated with elevated PC activity in healthy adults. We confirmed that there are differences in the proportions of subjects with elevated PC and PS depending on the assay used.

摘要

背景

在进行易栓症筛查时会评估蛋白C（PC）、游离蛋白S（PS）和抗凝血酶（AT）的水平，以排除其缺乏情况。

目的

本研究旨在调查决定健康个体中天然血浆抗凝剂水平升高的因素。

材料与方法

对130名年龄在20至60岁（中位数41岁）的健康成年人（63名男性）进行了PC活性和抗原、游离PS抗原、AT活性以及血液学、生化、遗传学和免疫学实验室检查。有心血管疾病和静脉血栓栓塞个人或家族史的个体不符合条件。

结果

通过发色底物法测定的功能活性PC（值高于140%）在14名（11%）受试者中观察到，而使用酶联免疫吸附测定（ELISA）测定的PC抗原在其中5名（4%）患者中升高。通过免疫比浊法和ELISA测定的游离PS在9名（7%）受试者中升高（男性值高于139%，女性高于114%），分别在6名（5%）患者中升高（男性值高于130%，女性高于111%）。使用发色底物法测定发现5名（4%）受试者的AT活性高于118%。没有个体存在任何天然抗凝剂缺乏情况。C反应蛋白（CRP）升高>3.0 mg/L与PC活性升高相关（比值比[OR]：11.14，95%置信区间[CI] 1.67 - 74.23）。通过免疫比浊法评估的游离PS升高和PC活性与高胆固醇血症相关（OR分别为：3.57，95% CI：1.09 - 10.06和OR：8.61，95% CI：1.07 - 69.04）。体重指数≥25 kg/m²与PC活性升高独立相关（OR：3.42，95 % CI：1.01 - 11.52）。未发现AT活性升高的危险因素。