Mannucci P M
Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Maggiore Hospital, Italy.
Br Med Bull. 1994 Oct;50(4):851-70. doi: 10.1093/oxfordjournals.bmb.a072930.
Sensitive and specific laboratory methods are now available to detect and diagnose states of coagulation activation, defined as a procoagulant imbalance between the production and inhibition of enzymes in the coagulation system short of fibrin deposition. Although most coagulation enzymes cannot be measured specifically and accurately, assays for activated factor XII and factor VII have recently become available. Activated protein C, the active enzyme of a major anticoagulant pathway, can also be measured. Indirect approaches to the detection of coagulation activation are to measure the plasma levels of peptides released from coagulation zymogens when they are converted into active enzymes and the stable complexes formed in plasma when such enzymes are neutralized by their naturally-occurring inhibitors. These assay methods have dramatically improved our understanding of the mechanistic role of coagulation activation in health and disease. However, their clinical predictive value and usefulness for choosing and monitoring antithrombotic therapy still need to be defined in prospective clinical studies.
现在已有灵敏且特异的实验室方法来检测和诊断凝血激活状态，凝血激活状态被定义为在凝血系统中酶的产生与抑制之间的促凝失衡，且尚未形成纤维蛋白沉积。尽管大多数凝血酶无法被特异性且准确地测量，但检测活化因子 XII 和因子 VII 的检测方法最近已出现。主要抗凝途径的活性酶——活化蛋白 C 也可以被检测。检测凝血激活的间接方法是测量凝血酶原转化为活性酶时从其中释放的肽段的血浆水平，以及当这些酶被其天然存在的抑制剂中和时在血浆中形成的稳定复合物。这些检测方法极大地增进了我们对凝血激活在健康和疾病中的机制作用的理解。然而，它们的临床预测价值以及在选择和监测抗血栓治疗方面的实用性仍需要在前瞻性临床研究中加以明确。
