Canzano Paola, Brambilla Marta, Porro Benedetta, Cosentino Nicola, Tortorici Elena, Vicini Stefano, Poggio Paolo, Cascella Andrea, Pengo Martino F, Veglia Fabrizio, Fiorelli Susanna, Bonomi Alice, Cavalca Viviana, Trabattoni Daniela, Andreini Daniele, Omodeo Salè Emanuela, Parati Gianfranco, Tremoli Elena, Camera Marina
Centro Cardiologico Monzino IRCCS, Milan, Italy.
Istituto Auxologico Italiano IRCCS, Milan, Italy.
JACC Basic Transl Sci. 2021 Mar;6(3):202-218. doi: 10.1016/j.jacbts.2020.12.009. Epub 2021 Feb 24.
The authors hypothesized that the cytokine storm described in COVID-19 patients may lead to consistent cell-based tissue factor (TF)-mediated activation of coagulation, procoagulant microvesicles (MVs) release, and massive platelet activation. COVID-19 patients have higher levels of TF platelets, TF granulocytes, and TF MVs than healthy subjects and coronary artery disease patients. Plasma MV-associated thrombin generation is present in prophylactic anticoagulated patients. A sustained platelet activation in terms of P-selectin expression and platelet-leukocyte aggregate formation, and altered nitric oxide/prostacyclin synthesis are also observed. COVID-19 plasma, added to the blood of healthy subjects, induces platelet activation similar to that observed in vivo. This effect was blunted by pre-incubation with tocilizumab, aspirin, or a P2Y inhibitor.
作者推测，新冠病毒病（COVID-19）患者中描述的细胞因子风暴可能导致基于细胞的组织因子（TF）介导的凝血持续激活、促凝微泡（MV）释放以及大量血小板激活。与健康受试者和冠状动脉疾病患者相比，COVID-19患者的TF血小板、TF粒细胞和TF MVs水平更高。预防性抗凝患者的血浆中存在与MV相关的凝血酶生成。还观察到在P-选择素表达和血小板-白细胞聚集体形成方面的持续血小板激活，以及一氧化氮/前列环素合成的改变。添加到健康受试者血液中的COVID-19血浆诱导的血小板激活与体内观察到的相似。用托珠单抗、阿司匹林或P2Y抑制剂预孵育可减弱这种作用。
