Cortellaro M, Cofrancesco E, Boschetti C, Mussoni L, Donati M B, Cardillo M, Catalano M, Gabrielli L, Lombardi B, Specchia G
Istituto di Medicina Interna, University of Milan, Italy.
Arterioscler Thromb. 1993 Oct;13(10):1412-7. doi: 10.1161/01.atv.13.10.1412.
A case-control comparison within the framework of the prospective, multidisciplinary PLAT Study was performed to assess whether altered baseline fibrinolytic variables were associated with an elevated risk of ischemic thrombotic events in patients with documented coronary, cerebral, and/or peripheral atherosclerotic disease. Fibrinogen, D-dimer, tissue plasminogen activator (t-PA) antigen, and fibrinolytic activity before and after venous stasis (delta = difference between the two values), t-PA inhibitor, and lipid levels in 60 atherosclerotic patients with a thrombotic event during the first year of follow-up were compared with those in 94 atherosclerotic patients without such events, who were matched for age, sex, and diagnosis at enrollment. Events were associated with a higher release of delta t-PA antigen (P = .047), higher D-dimer (P = .024), and higher t-PA inhibitor (P = .001) levels. delta Fibrinolytic activity was correlated inversely with t-PA inhibitor (P < .01) and triglycerides (P < .05). D-Dimer was also correlated with systolic blood pressure (P < .01). Atherosclerotic patients at higher risk of thrombotic ischemic events are characterized by increased fibrin turnover and impaired fibrinolytic activity due to high t-PA inhibitor levels. This hemostatic disequilibrium may participate with conventional risk factors such as elevated triglyceride levels and systolic blood pressure in the multifactorial mechanism of ischemic sequelae in patients with preexisting vascular atherothrombotic disease.
在多学科前瞻性PLAT研究框架内进行了病例对照比较，以评估基线纤溶变量的改变是否与有冠状动脉、脑和/或外周动脉粥样硬化疾病记录的患者发生缺血性血栓事件的风险升高相关。比较了60例在随访第一年发生血栓事件的动脉粥样硬化患者与94例无此类事件的动脉粥样硬化患者的纤维蛋白原、D - 二聚体、组织纤溶酶原激活物（t - PA）抗原、静脉淤滞前后的纤溶活性（δ=两个值之间的差值）、t - PA抑制剂和血脂水平，后者在年龄、性别和入组时的诊断方面进行了匹配。事件与较高的δt - PA抗原释放（P = .047）、较高的D - 二聚体（P = .024）和较高的t - PA抑制剂水平（P = .001）相关。δ纤溶活性与t - PA抑制剂（P < .01）和甘油三酯（P < .05）呈负相关。D - 二聚体也与收缩压相关（P < .01）。血栓性缺血事件风险较高的动脉粥样硬化患者的特征是纤维蛋白周转增加和由于高t - PA抑制剂水平导致的纤溶活性受损。这种止血失衡可能与传统危险因素如甘油三酯水平升高和收缩压一起参与已有血管动脉粥样硬化血栓形成疾病患者缺血后遗症的多因素机制。
