Negreva Mariya, Georgiev Svetoslav, Vitlianova Katerina
1 First Clinic of Cardiology, Varna University Hospital "St. Marina," Varna, Bulgaria.
2 Second Clinic of Cardiology, Varna University Hospital "St. Marina," Varna, Bulgaria.
Clin Appl Thromb Hemost. 2017 Oct;23(7):793-799. doi: 10.1177/1076029616654262. Epub 2016 Jun 16.
Increased coagulation activity has been established in paroxysmal atrial fibrillation (PAF), but data on the anticoagulant system are scarce.
To examine the protein C anticoagulant pathway in the early hours of the disease.
Fifty-one patients (26 men and 25 women; mean age 59.84 ± 1.60 years) and 52 controls (26 men and 26 women; mean age 59.50 ± 1.46 years) were selected for the study. Protein C antigen and its activity, total protein S, free protein S and its activity, soluble forms of endothelial protein C receptor (sEPCR), and thrombomodulin (sTM) were examined in the plasma.
The indicators were studied in patients between the 2nd and the 24th hour after the onset of arrhythmia. Levels of protein C were significantly elevated in patients compared to controls (111.40% ± 6.66% vs 94.83% ± 4.47%; P = .039). Protein C activity showed significant reduction in PAF (73.13% ± 5.80% vs 103.3% ± 3.80%; P < .001). Total protein S levels did not differ significantly (108.20% ± 4.07% vs 102.40% ± 3.65%; P = .30). Free protein S (76.81% ± 6.01% vs 122.10% ± 3.97%; P < .001) and its activity (71.39% ± 6.27% vs 119.50% ± 6.54%; P < .001) were reduced in patients. Higher levels of sEPCR (203.10 ± 10.33 vs 133.10 ± 7.37 ng/mL; P < .001) and sTM (6.50±0.40 vs 4.48±0.28 ng/mL; P < .001) were measured in PAF.
Protein C activity is reduced still in the first hours (until the 24th hour) of PAF clinical manifestation, determining reduced activity of the anticoagulant pathway as a whole. The established low levels of free protein S and its activity as well as low sEPCR and sTM levels are a possible explanation of the changes in protein C activity.
阵发性心房颤动（PAF）患者的凝血活性增强已得到证实，但关于抗凝系统的数据却很少。
研究疾病早期的蛋白C抗凝途径。
选取51例患者（26例男性和25例女性；平均年龄59.84±1.60岁）和52例对照者（26例男性和26例女性；平均年龄59.50±1.46岁）进行研究。检测血浆中蛋白C抗原及其活性、总蛋白S、游离蛋白S及其活性、内皮细胞蛋白C受体（sEPCR）的可溶性形式和血栓调节蛋白（sTM）。
在心律失常发作后第2至24小时对患者进行指标研究。与对照组相比，患者的蛋白C水平显著升高（111.40%±6.66%对94.83%±4.47%；P = 0.039）。PAF患者的蛋白C活性显著降低（73.13%±5.80%对103.3%±3.80%；P < 0.001）。总蛋白S水平无显著差异（108.20%±4.07%对102.40%±3.65%；P = 0.30）。患者的游离蛋白S（76.81%±6.01%对122.10%±3.97%；P < 0.001）及其活性（71.39%±6.27%对119.50%±6.54%；P < 0.001）降低。PAF患者的sEPCR（203.10±10.33对133.10±7.37 ng/mL；P < 0.001）和sTM（6.50±0.40对4.48±0.28 ng/mL；P < 0.001）水平较高。
在PAF临床表现的最初几个小时（直至第24小时），蛋白C活性仍降低，这决定了整个抗凝途径的活性降低。游离蛋白S及其活性以及sEPCR和sTM水平降低，这可能是蛋白C活性变化的原因。
