创伤后 3 小时内细胞外囊泡相关促凝活性最高，此后显著下降：一项前瞻性观察性初步研究。
Extracellular vesicle-associated procoagulant activity is highest the first 3 hours after trauma and thereafter declines substantially: A prospective observational pilot study.
机构信息
From the Department of Research (I.N.R., K.G.B.), The Norwegian Air Ambulance Foundation; Institute of Clinical Medicine (I.N.R., M.H., W.O., T.E., C.E.H.), Faculty of Medicine, University of Oslo; Department of Medical Biochemistry (M.H., C.E.H.), Division of Laboratory Medicine, Department of Anaesthesiology (W.O., T.E.), Division of Emergencies and Critical Care, Oslo University Hospital; and Institute of Basic Medical Sciences (K.G.B.), Faculty of Medicine, University of Oslo, Oslo, Norway.
出版信息
J Trauma Acute Care Surg. 2021 Oct 1;91(4):681-691. doi: 10.1097/TA.0000000000003333.
BACKGROUND
Trauma patients have high concentrations of circulating extracellular vesicles (EVs) following injury, but the functional role of EVs in this setting is only partly deciphered. We aimed to describe in detail EV-associated procoagulant activity in individual trauma patients during the first 12 hours after injury to explore their putative function and relate findings to relevant trauma characteristics and outcome.
METHODS
In a prospective observational study of 33 convenience recruited trauma patients, citrated plasma samples were obtained at trauma center admission and 2, 4, 6, and 8 hours thereafter. We measured thrombin generation from isolated EVs and the procoagulant activity of phosphatidylserine (PS)-exposing EVs. Correlation and multivariable linear regression analyses were used to explore associations between EV-associated procoagulant activity and trauma characteristics as well as outcome measures.
RESULTS
EV-associated procoagulant activity was highest in the first 3 hours after injury. EV-associated thrombin generation normalized within 7 to 12 hours of injury, whereas the procoagulant activity of PS-exposing EVs declined to a level right above that of healthy volunteers. Increased EV-associated procoagulant activity at admission was associated with higher New Injury Severity Score, lower admission base excess, higher admission international normalized ratio, prolonged admission activated partial thromboplastin time, higher Sequential Organ Failure Assessment score at day 0, and fewer ventilator-free days.
CONCLUSION
Our data suggest that EVs have a transient hypercoagulable function and may play a role in the early phase of hemostasis after injury. The role of EVs in trauma-induced coagulopathy and posttraumatic thrombosis should be studied bearing in mind this novel temporal pattern.
LEVEL OF EVIDENCE
Prognostic/epidemiologic, level V.
背景
创伤患者在受伤后循环细胞外囊泡（EVs）浓度升高，但 EVs 在这种情况下的功能作用尚未完全阐明。我们旨在详细描述创伤后 12 小时内个体创伤患者的 EV 相关促凝活性，以探索其潜在功能，并将发现与相关创伤特征和结果相关联。
方法
在一项 33 例便利招募的创伤患者前瞻性观察研究中，在创伤中心入院时以及随后的 2、4、6 和 8 小时采集枸橼酸盐血浆样本。我们测量了从分离的 EV 中生成的凝血酶和暴露 PS 的 EV 的促凝活性。使用相关和多元线性回归分析来探讨 EV 相关促凝活性与创伤特征以及结果测量之间的关联。
结果
EV 相关促凝活性在受伤后 3 小时内最高。EV 相关凝血酶生成在受伤后 7 至 12 小时内恢复正常，而暴露 PS 的 EV 的促凝活性下降到接近健康志愿者的水平。入院时增加的 EV 相关促凝活性与较高的新损伤严重程度评分、较低的入院基础不足、较高的入院国际标准化比值、较长的入院激活部分凝血活酶时间、0 天更高的序贯器官衰竭评估评分以及更少的无呼吸机天数相关。
结论
我们的数据表明，EVs 具有短暂的高凝功能，可能在损伤后早期止血中发挥作用。应考虑到这种新的时间模式，研究 EV 在创伤诱导的凝血障碍和创伤后血栓形成中的作用。
证据水平
预后/流行病学，V 级。
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