Department of Laboratory Medicine, Ruijin Hospital, 66281Shanghai Jiao tong University School of Medicine, Shanghai, China.
State Key Laboratory of Medical Genomics, 538846Shanghai Institute of Hematology, Ruijin Hospital, Shanghai Jiao tong University School of Medicine, Shanghai, China.
Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620944471. doi: 10.1177/1076029620944471.
The changes in the coagulation, fibrinolytic, and endothelial functions are correlated with the pathophysiology of the thromboembolic diseases during acute illness. However, these changes in patients with hereditary thrombophilia who were not in the acute stage of venous thromboembolism (VTE) are unclear. A panel of 4 biomarkers, including thrombin-antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), tissue-type plasminogen activator/plasminogen activator inhibitor-1 complex (t-PAIC), and soluble thrombomodulin (sTM), were assayed in 100 healthy controls and 100 patients with thrombophilia. Although significantly higher concentrations of TAT, PIC, t-PAIC, and sTM were observed in patients with thrombophilia than in healthy controls, 70 patients showed absolutely normal levels of the above 4 biomarkers. Among the other 30 patients who had at least 1 biomarker out of the corresponding reference interval, 26 of them presented elevated PIC with or without increased TAT. Except for sTM, other 3 biomarkers did not show significant differences in patients with previous VTE compared to those without. Patients with single episode of VTE had obviously lower t-PAIC than those with multiple episodes of VTE, whereas the levels of TAT, PIC, and sTM were unassociated with the number of thrombosis episodes. Most thrombophilia patients who were not in the acute stage of VTE showed normal coagulation, fibrinolytic, and endothelial functions. Thus, we were unable to show that the one-time response of this panel was clinically helpful in determining thrombosis risk in thrombophilia individuals. Future studies should focus on the dynamic monitoring during the chronic phase of VTE to offer special advantages for patients with thrombophilia.
在急性疾病期间，凝血、纤维蛋白溶解和血管内皮功能的变化与血栓栓塞性疾病的病理生理学相关。然而，在没有处于静脉血栓栓塞（VTE）急性阶段的遗传性血栓形成倾向患者中，这些变化尚不清楚。在 100 名健康对照者和 100 名血栓形成倾向患者中，检测了包括凝血酶-抗凝血酶复合物（TAT）、纤溶酶-α2-纤溶酶抑制剂复合物（PIC）、组织型纤溶酶原激活物/纤溶酶原激活物抑制剂-1 复合物（t-PAIC）和可溶性血栓调节蛋白（sTM）在内的 4 种生物标志物的变化。尽管与健康对照组相比，血栓形成倾向患者的 TAT、PIC、t-PAIC 和 sTM 浓度明显更高，但有 70 名患者的上述 4 种生物标志物的绝对水平正常。在其他 30 名至少有 1 种生物标志物超出相应参考区间的患者中，26 名患者的 PIC 升高，伴有或不伴有 TAT 升高。除了 sTM 外，其他 3 种生物标志物在有或无先前 VTE 的患者之间没有显著差异。单次 VTE 发作的患者的 t-PAIC 明显低于多次 VTE 发作的患者，而 TAT、PIC 和 sTM 的水平与血栓发作次数无关。大多数不在 VTE 急性阶段的血栓形成倾向患者显示出正常的凝血、纤维蛋白溶解和血管内皮功能。因此，我们无法表明该标志物单次反应在确定血栓形成倾向个体的血栓形成风险方面具有临床帮助。未来的研究应集中在 VTE 的慢性阶段进行动态监测，为血栓形成倾向患者提供特殊优势。
