White Nathan J, Taflin Nicholas, Lim Esther B, Akaraborworn Osaree
Department of Emergency Medicine, University of Washington Emergency Medicine Research Laboratory, Seattle, Washington, USA.
Division of Trauma Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Blood Coagul Fibrinolysis. 2018 Jun;29(4):356-360. doi: 10.1097/MBC.0000000000000695.
: There is significant variability in blood coagulation among world populations. In particular, there may exist important differences in regulation of the fibrinolytic system in Asian populations that contribute to diseases of thrombosis and hemostasis. To investigate this issue, we compared fibrinogen concentration, plasma clot formation, and fibrinolytic resistance of healthy Asian subjects from Hat Yai, Songkhla, Thailand (Thai) vs. healthy North American subjects from Seattle, Washington, USA (SEA). Citrated plasma samples were obtained from healthy adult volunteers. Fibrinogen concentration was measured in plasma by the method of Clauss to examine for baseline differences of fibrinogen concentration. Samples were then standardized to 2.8 mg/ml fibrinogen using physiological buffer for each sample prior to fibrinolytic testing using rotational thromboelastometry (ROTEM) to examine for differences of clot lysis not attributable to fibrinogen concentration alone. Clot lysis was examined with ROTEM extrinsic pathway activation in the presence of 0, 0.5, and 1.0 μg/ml of tissue plasminogen activator (tPA). Two-way repeated measures analysis of variance was used to determine the effects of tPA and study group on ROTEM parameters. N = 49 Thai samples were compared with N = 58 SEA samples. Mean (SD) fibrinogen concentration was significantly increased for the Thai group at 4.03 (0.79) mg/ml vs. the SEA group at 3.66 (0.70) mg/ml (t test P = 0.014). After standardization of all samples to equivalent fibrinogen concentration, there were no differences in clot formation between groups without tPA. There was a significant effect of increasing tPA concentration on all ROTEM parameters except for clotting time. There were significant individual differences for amplitude at 10 min and lysis onset time, where amplitude at 10 min was significantly increased and lysis onset time was significantly prolonged for Thai vs. SEA at tPA concentrations of 0.5 and 1.0 μg/ml. Variability in thrombosis and hemostasis in Asians vs. other populations is likely to involve differences of fibrinogen concentration and regulation of clot lysis.
世界不同人群的血液凝固存在显著差异。特别是，亚洲人群中纤维蛋白溶解系统的调节可能存在重要差异，这与血栓形成和止血相关疾病有关。为了研究这个问题，我们比较了来自泰国宋卡府合艾市的健康亚洲受试者（泰国人）与来自美国华盛顿州西雅图的健康北美受试者（SEA）的纤维蛋白原浓度、血浆凝块形成和纤维蛋白溶解抗性。从健康成年志愿者中获取枸橼酸盐血浆样本。采用克劳斯法测定血浆中的纤维蛋白原浓度，以检查纤维蛋白原浓度的基线差异。然后在使用旋转血栓弹力图（ROTEM）进行纤维蛋白溶解测试之前，使用生理缓冲液将每个样本的纤维蛋白原标准化至2.8mg/ml，以检查仅由纤维蛋白原浓度引起的凝块溶解差异之外的凝块溶解差异。在存在0、0.5和1.0μg/ml组织纤溶酶原激活剂（tPA）的情况下，通过ROTEM外源性途径激活来检查凝块溶解情况。采用双向重复测量方差分析来确定tPA和研究组对ROTEM参数的影响。将49份泰国样本与58份SEA样本进行比较。泰国组的平均（标准差）纤维蛋白原浓度显著高于SEA组，分别为4.03（0.79）mg/ml和3.66（0.70）mg/ml（t检验P=0.014）。在将所有样本标准化至等效纤维蛋白原浓度后，在没有tPA的情况下，两组之间的凝块形成没有差异。除凝血时间外，tPA浓度增加对所有ROTEM参数均有显著影响。在tPA浓度为0.5和1.0μg/ml时，泰国人与SEA相比，10分钟时的振幅和溶解起始时间存在显著个体差异，其中10分钟时的振幅显著增加，溶解起始时间显著延长。亚洲人与其他人群在血栓形成和止血方面的差异可能涉及纤维蛋白原浓度和凝块溶解调节的差异。
