Kyriakopoulos Christos, Chronis Christos, Papapetrou Evaggelia, Tatsioni Athina, Gartzonika Konstantina, Tsaousi Christina, Gogali Athena, Katsanos Christos, Vaggeli Aikaterini, Tselepi Charikleia, Daskalopoulos Georgios, Konstantopoulos Stavros, Kostikas Konstantinos, Konstantinidis Athanasios
Respiratory Medicine Dept, University Hospital of Ioannina, Ioannina, Greece.
University Hospital of Ioannina, Hematology Laboratory, Ioannina, Greece.
ERJ Open Res. 2021 Nov 1;7(4). doi: 10.1183/23120541.00297-2021. eCollection 2021 Oct.
COPD patients have an increased risk of cardiovascular disease and venous thromboembolism.
This study aimed to investigate whether patients with stable COPD have a prothrombotic state compared to COPD-free smokers. We conducted an observational study comparing levels of: D-dimers, INR, aPTT, coagulation factors; fibrinogen, FII, FV, FVII, FVIII, FIX, FX and coagulation inhibitors; protein S, proteins C and antithrombin between stable COPD patients and control subjects.
A total of 103 COPD patients and 42 controls with similar age, sex, current smoking status, comorbidity burden and cardiovascular risk met the inclusion criteria. Compared to controls, COPD patients had higher levels of D-dimers (median (interquartile range): 360 (230-600) ng·mL 240 (180-400) ng·mL, p=0.001), fibrinogen (mean±sd: 399±82 mg·dL 346±65 mg·dL, p<0.001), FII (122±22% 109±19%, p=0.004), FV (131±25% 121±19%, p=0.015), FVIII (143±32% 122±20%, p<0.001) and FX (111 (94-134)% 98 (88-107)%, p=0.002), and lower levels of protein S (95 (85-105)% 116 (98-121)%, p<0.001) and antithrombin (94.4±11.5% 102.3±13.2%, p=0.001). In the COPD group, patients with more severe airflow limitation and frequent exacerbations had significantly higher levels of FII, FV and FX, whereas patients with higher COPD assessment test score had significantly higher levels of FX and lower levels of protein S.
Patients with stable COPD exhibited increased levels of key coagulation factors and decreased levels of coagulation inhibitors, namely protein S and antithrombin, compared to COPD-free smokers. Among COPD patients, increased levels of FII, FV and FX and decreased levels of protein S were found in patients with more severe disease.
慢性阻塞性肺疾病（COPD）患者发生心血管疾病和静脉血栓栓塞的风险增加。
本研究旨在调查与无COPD的吸烟者相比，稳定期COPD患者是否处于血栓前状态。我们进行了一项观察性研究，比较了稳定期COPD患者与对照组之间的以下指标水平：D - 二聚体、国际标准化比值（INR）、活化部分凝血活酶时间（aPTT）、凝血因子；纤维蛋白原、凝血因子II（FII）、凝血因子V（FV）、凝血因子VII（FVII）、凝血因子VIII（FVIII）、凝血因子IX（FIX）、凝血因子X（FX）和凝血抑制剂；蛋白S、蛋白C和抗凝血酶。
共有103例COPD患者和42例年龄、性别、当前吸烟状况、合并症负担和心血管风险相似的对照组符合纳入标准。与对照组相比，COPD患者的D - 二聚体水平更高（中位数（四分位间距）：360（230 - 600）ng·mL对240（180 - 400）ng·mL，p = 0.001）、纤维蛋白原水平更高（均值±标准差：399±82mg·dL对346±65mg·dL，p < 0.001）、FII水平更高（122±22%对109±19%，p = 0.004）、FV水平更高（131±25%对121±19%，p = 0.015）、FVIII水平更高（143±32%对122±20%，p < 0.001）和FX水平更高（111（94 - 134）%对98（88 - 107）%，p = 0.002），而蛋白S水平更低（95（85 - 105）%对116（98 - 121）%，p < 0.001）和抗凝血酶水平更低（94.4±11.5%对102.3±13.2%，p = 0.001）。在COPD组中，气流受限更严重且急性加重频繁的患者FII、FV和FX水平显著更高，而COPD评估测试评分更高的患者FX水平显著更高且蛋白S水平更低。
与无COPD的吸烟者相比，稳定期COPD患者的关键凝血因子水平升高，而凝血抑制剂即蛋白S和抗凝血酶水平降低。在COPD患者中，病情更严重的患者FII、FV和FX水平升高且蛋白S水平降低。
