Feffer S E, Fox R L, Orsen M M, Harjai K J, Glatt A E
Department of Medicine, Nassau County Medical Center, East Meadow, NY 11554, USA.
South Med J. 1995 Nov;88(11):1126-30. doi: 10.1097/00007611-199511000-00008.
Previous publications have described thrombotic events with unclear causes in individuals infected with the human immunodeficiency virus (HIV). We stratified the cases of 52 individuals infected with HIV by degree of immunosuppression and the presence of complicating illnesses. Plasma from these individuals was screened for abnormalities that might predispose to thromboses. We found statistically significant differences between patients with CD4 counts < 200/mm3 and those whose CD4 counts were > 400/mm3 in the following: d-dimers, functional protein C, antigenic protein C, total protein S antigen, free protein S antigen, C4b-binding protein (C4b-BP), and von Willebrand antigen (vWD). Free protein S correlated inversely with C4b-BP; vWD directly with total protein S; and protein C inversely with d-dimers. D-dimers were significantly elevated only in immunosuppressed patients with complicating neoplastic/inflammatory disease. We propose that low-grade disseminated intravascular coagulopathy in severely immunosuppressed individuals with HIV and infectious, inflammatory, or neoplastic complications is responsible for depressed protein C, which, together with elevations in total protein S and vWD (markers of endothelial injury), indicates a thrombotic predisposition.
以往的出版物描述了感染人类免疫缺陷病毒（HIV）的个体发生的病因不明的血栓形成事件。我们根据免疫抑制程度和并发疾病的存在情况，对52例感染HIV的个体病例进行了分层。对这些个体的血浆进行筛查，以寻找可能易患血栓形成的异常情况。我们发现，在以下方面，CD4计数<200/mm3的患者与CD4计数>400/mm3的患者之间存在统计学上的显著差异：D-二聚体、功能性蛋白C、抗原性蛋白C、总蛋白S抗原、游离蛋白S抗原、C4b结合蛋白（C4b-BP）和血管性血友病因子抗原（vWD）。游离蛋白S与C4b-BP呈负相关；vWD与总蛋白S呈正相关；蛋白C与D-二聚体呈负相关。仅在伴有肿瘤/炎症性并发疾病的免疫抑制患者中，D-二聚体显著升高。我们提出，在患有HIV且伴有感染、炎症或肿瘤并发症的严重免疫抑制个体中，低度弥散性血管内凝血导致蛋白C降低，这与总蛋白S和vWD（内皮损伤标志物）升高一起，表明存在血栓形成倾向。
