Salomaa V, Stinson V, Kark J D, Folsom A R, Davis C E, Wu K K
Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland.
Circulation. 1995 Jan 15;91(2):284-90. doi: 10.1161/01.cir.91.2.284.
Thrombosis, provoked by a rupture of an atherosclerotic plaque, plays a crucial role in precipitating a coronary heart disease event. Its role at the early stage of atherosclerosis has, however, been unclear, but it has been hypothesized that thrombosis or defective fibrinolysis contributes to the progression of atherosclerotic lesions.
We studied the association of plasminogen activator inhibitor antigen (PAI-1), tissue-type plasminogen activator antigen (TPA), and D-dimer with early atherosclerosis in a cross-sectional case-control study involving 457 pairs chosen from the biracial cohort of the Atherosclerosis Risk in Communities (ARIC) Study. As examined by B-mode ultrasound, patients (cases) had intima-media thickness of carotid arteries above the 90th percentile and control subjects had thickness below the 75th percentile of the ARIC cohort. Persons with a history of heart disease, stroke, or claudication were excluded from the case-control selection. PAI-1, TPA, and D-dimer were higher in patients than in control subjects (P < or = .001, Wilcoxon signed rank statistic). In conditional logistic regression analyses, the odds ratios of carotid atherosclerosis were, for PAI-1, for example, 1.22, 1.54, and 1.60 in the second, third, and fourth quartiles compared with the first quartile (P < .0001, test of linear trend, adjusting for age, systolic blood pressure, total cholesterol, acetylsalicylic acid use, and time of blood draw). Corresponding tests for D-dimer and TPA also showed an increasing trend (P < .0001).
The findings support the hypothesis that thrombosis and fibrinolysis play a role at the early stage of the atherosclerotic process.
动脉粥样硬化斑块破裂引发的血栓形成在冠心病事件的发生中起关键作用。然而，其在动脉粥样硬化早期阶段的作用尚不清楚，但有假说认为血栓形成或纤维蛋白溶解功能缺陷会促使动脉粥样硬化病变进展。
我们在一项横断面病例对照研究中，对从社区动脉粥样硬化风险（ARIC）研究的双种族队列中选取的457对研究对象进行了研究，以探讨纤溶酶原激活物抑制剂抗原（PAI-1）、组织型纤溶酶原激活物抗原（TPA）和D-二聚体与早期动脉粥样硬化的关联。通过B型超声检查，患者（病例组）颈动脉内膜中层厚度高于ARIC队列的第90百分位数，而对照者的厚度低于第75百分位数。病例对照选择中排除了有心脏病、中风或间歇性跛行病史的人。患者的PAI-1、TPA和D-二聚体水平高于对照者（P≤0.001，Wilcoxon符号秩统计量）。在条件逻辑回归分析中，例如，与第一四分位数相比，PAI-1在第二、第三和第四四分位数时颈动脉粥样硬化的比值比分别为1.22、1.54和1.60（P<0.0001，线性趋势检验，校正年龄、收缩压、总胆固醇、阿司匹林使用情况和采血时间）。D-二聚体和TPA的相应检验也显示出增加趋势（P<0.0001）。
这些发现支持了血栓形成和纤维蛋白溶解在动脉粥样硬化进程早期起作用的假说。
