Brännström M, Jansson J H, Boman K, Nilsson T K
Department of Medicine, Skellefteå Hospital, Umeå, Sweden.
Thromb Haemost. 1995 Aug;74(2):612-5.
The aim of the present study was to test if long-term mortality could be predicted by endothelial derived haemostatic variables in a population with high morbidity due to thromboembolic disease. Plasma samples were drawn from 212 out-patients treated with oral anticoagulants, at the beginning of the study, and analyzed for mass concentration of tissue plasminogen activator (tPA) and its inhibitor (PAI-1), and von Willebrand factor. In the course of 3.8-year follow-up 45 patients died, including 38 vascular deaths. We found that all-cause mortality was significantly associated with increased levels of vWF and tPA. For vascular mortality there was a significant association with all three haemostatic variables (tPA, PAI-1, vWF). For vWF there was a 3-fold increase in total and vascular mortality in the highest quartile compared to the lowest quartile. There were 27 vascular deaths in the group of patients with a tPA-value above the median compared to 11 in those with a tPA below the median. In multivariate Cox regression analysis (including: age, sex, smoking habits, body mass index, diabetes mellitus, hypertension, tPA, PAI-1, and vWF), vWF and smoking were independently significantly associated with all-cause mortality, and tPA and age with vascular mortality. Endothelial derived haemostatic variables are predictors of total and vascular mortality in patients treated with oral anticoagulants.
本研究的目的是检验在因血栓栓塞性疾病而发病率较高的人群中，内皮源性止血变量是否能够预测长期死亡率。在研究开始时，从212名接受口服抗凝剂治疗的门诊患者中采集血浆样本，分析组织型纤溶酶原激活物（tPA）及其抑制剂（PAI-1）以及血管性血友病因子的质量浓度。在3.8年的随访过程中，45名患者死亡，其中包括38例血管性死亡。我们发现全因死亡率与血管性血友病因子（vWF）和tPA水平升高显著相关。对于血管性死亡率，与所有三个止血变量（tPA、PAI-1、vWF）均存在显著关联。与最低四分位数相比，最高四分位数的vWF在总死亡率和血管性死亡率方面均增加了3倍。tPA值高于中位数的患者组中有27例血管性死亡，而tPA低于中位数的患者组中有11例。在多变量Cox回归分析（包括：年龄、性别、吸烟习惯、体重指数、糖尿病、高血压、tPA、PAI-1和vWF）中，vWF和吸烟与全因死亡率独立显著相关，tPA和年龄与血管性死亡率独立显著相关。内皮源性止血变量是接受口服抗凝剂治疗患者总死亡率和血管性死亡率的预测指标。
