正汉坦病毒感染期间循环细胞外囊泡组织因子活性与血管内凝血相关。

Circulating Extracellular Vesicle Tissue Factor Activity During Orthohantavirus Infection Is Associated With Intravascular Coagulation.

机构信息

Department of Medicine, Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carlina, USA.

Department of Viroscience, Erasmus University Medical Center, Rotterdam, Netherlands.

出版信息

J Infect Dis. 2020 Sep 14;222(8):1392-1399. doi: 10.1093/infdis/jiz597.

DOI:10.1093/infdis/jiz597

PMID:31722433

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7488197/

Abstract

BACKGROUND

Puumala orthohantavirus (PUUV) causes hemorrhagic fever with renal syndrome (HFRS). Patients with HFRS have an activated coagulation system with increased risk of disseminated intravascular coagulation (DIC) and venous thromboembolism (VTE). The aim of the study was to determine whether circulating extracellular vesicle tissue factor (EVTF) activity levels associates with DIC and VTE (grouped as intravascular coagulation) in HFRS patients.

METHODS

Longitudinal samples were collected from 88 HFRS patients. Patients were stratified into groups of those with intravascular coagulation (n = 27) and those who did not (n = 61). We measured levels of circulating EVTF activity, fibrinogen, activated partial prothrombin time, D-dimer, tissue plasminogen activator (tPA), plasminogen activator inhibitor 1 (PAI-1), and platelets.

RESULTS

Plasma EVTF activity was transiently increased during HFRS. Levels of EVTF activity were significantly associated with plasma tPA and PAI-1, suggesting that endothelial cells could be a potential source. Patients with intravascular coagulation had significantly higher peak EVTF activity levels compared with those who did not, even after adjustment for sex and age. The peak EVTF activity value predicting intravascular coagulation was 0.51 ng/L with 63% sensitivity and 61% specificity with area under the curve = 0.63 (95% confidence interval, 0.51-0.76) and P = .046.

CONCLUSIONS

Plasma EVTF activity during HFRS is associated with intravascular coagulation.

摘要

背景

普马拉型汉坦病毒（PUUV）可引起肾综合征出血热（HFRS）。HFRS 患者的凝血系统被激活，弥散性血管内凝血（DIC）和静脉血栓栓塞（VTE）的风险增加。本研究旨在确定 HFRS 患者循环细胞外囊泡组织因子（EVTF）活性水平是否与 DIC 和 VTE（归类为血管内凝血）相关。

方法

从 88 例 HFRS 患者中采集纵向样本。将患者分为血管内凝血组（n=27）和非血管内凝血组（n=61）。我们测量了循环 EVTF 活性、纤维蛋白原、活化部分凝血酶原时间、D-二聚体、组织型纤溶酶原激活物（tPA）、纤溶酶原激活物抑制剂 1（PAI-1）和血小板。

结果

HFRS 期间血浆 EVTF 活性短暂升高。EVTF 活性水平与血浆 tPA 和 PAI-1 显著相关，表明内皮细胞可能是潜在的来源。与无血管内凝血的患者相比，有血管内凝血的患者的 EVTF 活性峰值水平显著升高，即使在调整性别和年龄后也是如此。预测血管内凝血的 EVTF 活性峰值值为 0.51ng/L，灵敏度为 63%，特异性为 61%，曲线下面积为 0.63（95%置信区间为 0.51-0.76），P=0.046。