Weymann Alexander, Sabashnikov Anton, Ali-Hasan-Al-Saegh Sadeq, Popov Aron-Frederik, Jalil Mirhosseini Seyed, Baker William L, Lotfaliani Mohammadreza, Liu Tong, Dehghan Hamidreza, Yavuz Senol, de Oliveira Sá Michel Pompeu Barros, Jang Jae-Sik, Zeriouh Mohamed, Meng Lei, D'Ascenzo Fabrizio, Deshmukh Abhishek J, Biondi-Zoccai Guiseppe, Dohmen Pascal M, Calkins Hugh, Cardiac Surgery And Cardiology-Group Imcsc-Group Integrated Meta-Analysis Of Cardiac
Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield Middlesex, United Kingdom.
Med Sci Monit Basic Res. 2017 Mar 31;23:97-140. doi: 10.12659/MSMBR.902558.
BACKGROUND The pathophysiological mechanism associated with the higher prothrombotic tendency in atrial fibrillation (AF) is complex and multifactorial. However, the role of prothrombotic markers in AF remains inconclusive. MATERIAL AND METHODS We conducted a meta-analysis of observational studies evaluating the association of coagulation activation, fibrinolytic, and endothelial function with occurrence of AF and clinical adverse events. A comprehensive subgroup analysis and meta-regression was performed to explore potential sources of heterogeneity. RESULTS A literature search of major databases retrieved 1703 studies. After screening, a total of 71 studies were identified. Pooled analysis showed the association of coagulation markers (D-dimer (weighted mean difference (WMD) =197.67 and p<0.001), fibrinogen (WMD=0.43 and p<0.001), prothrombin fragment 1-2 (WMD=0.53 and p<0.001), antithrombin III (WMD=23.90 and p=0.004), thrombin-antithrombin (WMD=5.47 and p=0.004)); fibrinolytic markers (tissue-type plasminogen activator (t-PA) (WMD=2.13 and p<0.001), plasminogen activator inhibitor (WMD=11.44 and p<0.001), fibrinopeptide-A (WMD=4.13 and p=0.01)); and endothelial markers (von Willebrand factor (WMD=27.01 and p<0.001) and soluble thrombomodulin (WMD=3.92 and p<0.001)) with AF. CONCLUSIONS The levels of coagulation, fibrinolytic, and endothelial markers have been reported to be significantly higher in AF patients than in SR patients.
心房颤动（AF）患者血栓形成倾向较高，其病理生理机制复杂且多因素。然而，促血栓形成标志物在AF中的作用仍无定论。材料与方法：我们对观察性研究进行了一项荟萃分析，评估凝血激活、纤维蛋白溶解和内皮功能与AF发生及临床不良事件的关联。进行了全面的亚组分析和荟萃回归，以探索异质性的潜在来源。结果：对主要数据库的文献检索共找到1703项研究。筛选后，共确定了71项研究。汇总分析显示凝血标志物（D-二聚体（加权平均差（WMD）=197.67，p<0.001）、纤维蛋白原（WMD=0.43，p<0.001）、凝血酶原片段1-2（WMD=0.53，p<0.001）、抗凝血酶III（WMD=23.90，p=0.004）、凝血酶-抗凝血酶（WMD=5.47，p=0.004））；纤维蛋白溶解标志物（组织型纤溶酶原激活物（t-PA）（WMD=2.13，p<0.001）、纤溶酶原激活物抑制剂（WMD=11.44，p<0.001）、纤维肽-A（WMD=4.13，p=0.01））；以及内皮标志物（血管性血友病因子（WMD=27.01，p<0.001）和可溶性血栓调节蛋白（WMD=3.92，p<0.001））与AF有关。结论：据报道，AF患者的凝血、纤维蛋白溶解和内皮标志物水平显著高于窦性心律（SR）患者。
