COVID-19 相关凝血病中的组织因子。

Tissue factor in COVID-19-associated coagulopathy.

机构信息

Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA.

Carter Immunology Center, University of Virginia, Charlottesville, VA 22908, USA; Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA.

出版信息

Thromb Res. 2022 Dec;220:35-47. doi: 10.1016/j.thromres.2022.09.025. Epub 2022 Oct 1.

Abstract

Evidence of micro- and macro-thrombi in the arteries and veins of critically ill COVID-19 patients and in autopsies highlight the occurrence of COVID-19-associated coagulopathy (CAC). Clinical findings of critically ill COVID-19 patients point to various mechanisms for CAC; however, the definitive underlying cause is unclear. Multiple factors may contribute to the prothrombotic state in patients with COVID-19. Aberrant expression of tissue factor (TF), an initiator of the extrinsic coagulation pathway, leads to thrombotic complications during injury, inflammation, and infections. Clinical evidence suggests that TF-dependent coagulation activation likely plays a role in CAC. Multiple factors could trigger abnormal TF expression and coagulation activation in patients with severe COVID-19 infection. Proinflammatory cytokines that are highly elevated in COVID-19 (IL-1β, IL-6 and TNF-α) are known induce TF expression on leukocytes (e.g. monocytes, macrophages) and non-immune cells (e.g. endothelium, epithelium) in other conditions. Antiphospholipid antibodies, TF-positive extracellular vesicles, pattern recognition receptor (PRR) pathways and complement activation are all candidate factors that could trigger TF-dependent procoagulant activity. In addition, coagulation factors, such as thrombin, may further potentiate the induction of TF via protease-activated receptors on cells. In this systematic review, with other viral infections, we discuss potential mechanisms and cell-type-specific expressions of TF during SARS-CoV-2 infection and its role in the development of CAC.

摘要

在危重症 COVID-19 患者的动静脉中以及尸检中都发现了微血栓和大血栓,这突显了 COVID-19 相关凝血病(CAC)的发生。危重症 COVID-19 患者的临床发现指向 CAC 的多种机制;然而,确切的根本原因尚不清楚。多种因素可能导致 COVID-19 患者处于血栓前状态。组织因子(TF)的异常表达,即外源性凝血途径的启动子,会导致损伤、炎症和感染期间发生血栓并发症。临床证据表明,TF 依赖性凝血激活可能在 CAC 中发挥作用。多种因素可能触发严重 COVID-19 感染患者的异常 TF 表达和凝血激活。在 COVID-19 中高度升高的促炎细胞因子(IL-1β、IL-6 和 TNF-α)已知可在其他情况下诱导白细胞(如单核细胞、巨噬细胞)和非免疫细胞(如内皮细胞、上皮细胞)上的 TF 表达。抗磷脂抗体、TF 阳性细胞外囊泡、模式识别受体(PRR)途径和补体激活都是可能触发 TF 依赖性促凝活性的候选因素。此外,凝血因子,如凝血酶,可通过细胞上的蛋白酶激活受体进一步增强 TF 的诱导。在本系统评价中,我们将结合其他病毒感染,讨论 SARS-CoV-2 感染期间 TF 的潜在机制和细胞类型特异性表达及其在 CAC 发展中的作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5eed/9525243/275ac4700f3d/gr1_lrg.jpg

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