脊髓损伤后早期高凝-低纤维蛋白溶解状态的发展。

Development of a Hypercoagulable-Hypofibrinolytic State Early After Spinal Cord Injury.

作者信息

Park Andrew J, Garcia Vinicius P, Greiner Jared J, Berry Auburn R, Cardenas Hannah L, Wegerson Kendra N, Stauffer Brian, DeSouza Christopher A

机构信息

Rocky Mountain Regional Spinal Injury System, Craig Hospital, Englewood, CO; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO.

Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, CO.

出版信息

Arch Phys Med Rehabil. 2024 May;105(5):843-849. doi: 10.1016/j.apmr.2023.11.001. Epub 2023 Nov 15.

DOI:10.1016/j.apmr.2023.11.001

PMID:37977547

Abstract

OBJECTIVES

To determine whether spinal cord injury (SCI) is associated with adverse changes in coagulation and fibrinolytic factors that underlie thrombogenesis and contribute to atherothrombotic events such as myocardial infarctions (MIs) and strokes.

DESIGN

Cross-sectional study.

SETTING

Neurorehabilitation hospital and general community.

PARTICIPANTS

Thirty young and middle-aged (20-58 years) adults (N=30) were studied: 14 non-injured community dwelling adults. (11M/4F) and 16 with subacute tetraplegic motor complete SCI during initial inpatient rehabilitation (13M/3F; time since injury: 11.8±5.3 wk).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Circulating markers of coagulation [von Willebrand factor (vWf) and factors VII, VIII, and X], the fibrinolytic system [tissue-type plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) antigen and activity], and fibrin formation (D-dimer) were determined by enzyme immunoassay.

RESULTS

Thirty young and middle-aged (20-58 years) adults were studied: 14 non-injured (11M/4F) and 16 with subacute tetraplegic motor complete SCI (13M/3F; time since injury: range 4-25 wk). Circulating levels of coagulation factors VII, VIII, and X were significantly higher (∼20%-45%; P<.05) in the adults with SCI than non-injured adults, whereas vWf was similar between groups. Fibrinolytic markers were adversely disrupted with SCI with t-PA antigen, PAI-1 antigen and PAI-1 activity were markedly higher (∼50%-800%; P<.05) in adults with SCI compared with non-injured adults. The molar concentration ratio of active t-PA to PAI-1 was significantly higher (∼350%) in adults with SCI. Concordant with coagulation cascade activation and fibrinolytic system inhibition, D-dimer concentrations were markedly ∼70% higher (P<.05) in adults with SCI compared with non-injured adults.

CONCLUSIONS

Subacute tetraplegic motor complete SCI is associated with a prothrombotic hemostatic profile. Adverse changes in the coagulation cascade and fibrinolytic system appear to occur early after injury and may contribute to the increased atherothrombotic risk in adults living with SCI.

摘要

目的

确定脊髓损伤 (SCI) 是否与凝血和纤维蛋白溶解因子的不良变化有关，这些因子是血栓形成的基础，导致心肌梗死 (MI) 和中风等动脉血栓栓塞事件。

设计

横断面研究。

地点

神经康复医院和普通社区。

参与者

研究了 30 名年轻和中年（20-58 岁）成年人（N=30）：14 名非损伤社区居住成年人。（11M/4F）和 16 名亚急性四肢瘫痪运动完全性 SCI 患者，在入院初期接受康复治疗（13M/3F；受伤时间：11.8±5.3 周）。

干预措施

不适用。

主要观察指标

通过酶免疫测定法测定凝血标志物[血管性血友病因子 (vWf) 和因子 VII、VIII 和 X]、纤维蛋白溶解系统[组织型纤溶酶原激活物 (t-PA)、纤溶酶原激活物抑制剂-1 (PAI-1) 抗原和活性]和纤维蛋白形成（D-二聚体）。

结果

研究了 30 名年轻和中年（20-58 岁）成年人：14 名非损伤（11M/4F）和 16 名亚急性四肢瘫痪运动完全性 SCI 患者（13M/3F；受伤时间：4-25 周）。与非损伤成年人相比，SCI 成年人的凝血因子 VII、VIII 和 X 水平显著升高（约 20%-45%；P<.05），而 vWf 在两组之间相似。纤维蛋白溶解标志物在 SCI 中受到不利影响，t-PA 抗原、PAI-1 抗原和 PAI-1 活性显著升高（约 50%-800%；P<.05），与非损伤成年人相比。SCI 成人的活性 t-PA 与 PAI-1 的摩尔浓度比显著升高（约 350%）。与凝血级联激活和纤维蛋白溶解系统抑制一致，SCI 成人的 D-二聚体浓度显著升高（约 70%；P<.05），与非损伤成年人相比。