凝血酶生成试验：自身免疫性疾病患者慢性炎症与止血之间的相互作用

Thrombin generation assay: interactions between chronic inflammation and haemostasis in patients with autoimmune diseases.

作者信息

Solfietti Laura, Binello Giovanni B, Stella Stefania, Bazzan Mario, Salierno Milena, Roccatello Dario

机构信息

Dept. of Rare, Immunologic, Haematologic and Immunohaematologic Diseases, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of Piemonte and Valle d'Aosta Network for Rare Diseases, Giovanni Bosco Hosp. and Univ. of Turin, Italy.

Dept. of Rare, Immunologic, Haematologic and Immunohaematologic Dis., Ctr.of Res.of Immunopathology and Rare Diseases, Coordinating Centre of Piemonte and Valle d'Aosta Network for Rare Dis.; and SCDU Nephrol.& Dialysis, Giovanni Bosco Hosp.,Turin, Italy.

出版信息

Clin Exp Rheumatol. 2016 Sep-Oct;34(5):925-928. Epub 2016 Jun 22.

PMID:27385196

Abstract

OBJECTIVES

Growing evidences show a direct link between inflammation and activation of haemostasis. That could increase thrombotic and cardiovascular risk in patients with active autoimmune diseases such as rheumatoid arthritis (RA) and systemic sclerosis (SSc). The aim of this study was to evaluate a possible hypercoagulable condition in RA and SSc patients, using the thrombin generation assay (TGA).

METHODS

TGA was assessed in 44 RA [33 with active disease (actRA) and 11 inactive (non-actRA)], 25 SSc patients and 41 healthy controls using a fluorimetric technique and the TGA RB Low reagent. The Lag time (tLag), the time to thrombin peak (tPeak), the maximal concentration of formed thrombin (Peak), the velocity of thrombin generation (velocity) and the total amount of thrombin generated (AUC) were determined.

RESULTS

As compared to the control group, tLag was found to be significantly reduced both in patients with actRA (p=0.0001) and non-actRA (p=0.01); tPeak was found to be reduced in actRA patients (p=0.0002). Similarly, as compared to healthy subjects, Peak and AUC were found to be increased in actRA patients (p=0.01; p=0.002), as well as D-dimer (p=0.01). Analysing SSc vs RA, a higher Peak and AUC were detected in RA patients.

CONCLUSIONS

The TGA profile identified in actRA patients (decreased tLag and tPeak combined with higher thrombin peak and greater AUC) reflects a hypercoagulable state that could make patients more susceptible to develop a cardiovascular disease.

摘要

目的

越来越多的证据表明炎症与止血激活之间存在直接联系。这可能会增加类风湿关节炎（RA）和系统性硬化症（SSc）等活动性自身免疫性疾病患者的血栓形成和心血管风险。本研究的目的是使用凝血酶生成试验（TGA）评估RA和SSc患者可能存在的高凝状态。

方法

使用荧光技术和TGA RB Low试剂对44例RA患者[33例活动性疾病（actRA）和11例非活动性疾病（non-actRA）]、25例SSc患者和41例健康对照者进行TGA评估。测定了滞后时间（tLag）、凝血酶峰值时间（tPeak）、形成的凝血酶最大浓度（Peak）、凝血酶生成速度（velocity）和生成的凝血酶总量（AUC）。

结果

与对照组相比，actRA患者（p=0.0001）和non-actRA患者（p=0.01）的tLag均显著缩短；actRA患者的tPeak缩短（p=0.0002）。同样，与健康受试者相比，actRA患者的Peak和AUC升高（p=0.01；p=0.002），D-二聚体也升高（p=0.01）。分析SSc与RA，RA患者的Peak和AUC更高。