Warshofsky M K, Wasserman H S, Wang W, Teng P, Sciacca R, Apfelbaum M, Schwartz A, Michler R E, Mancini D M, Cannon P J, Rabbani L E
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Am J Cardiol. 1997 Jul 15;80(2):145-9. doi: 10.1016/s0002-9149(97)00308-1.
Hemostatic factors are involved in the pathogenesis of native coronary artery disease. However, their role in transplant coronary artery disease is less established. To assess the role of hemostatic factors in transplant coronary artery disease we studied 52 consecutive cardiac transplant patients. The presence of transplant coronary artery disease was determined by angiography. Plasma levels of tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), von Willebrand Factor (vWF), and fibrin D-dimer were determined by enzyme-linked immunosorbent assays. Serum lipids were measured by enzymatic methods. Patients with transplant coronary artery disease had higher circulating t-PA (8.6 +/- 0.8 vs. 5.4 +/- 0.6 ng/ml, p = 0.021) and PAI-1 antigen concentrations (38.0 +/- 3.4 vs 25.8 +/- 2.2 ng/ml, p = 0.037). t-PA and PAI-1 antigen concentrations correlated with the severity of angiographic disease (R = 0.34; p = 0.014 for t-PA, and R = 0.45; p = 0.001 for PAI-1). Serum cholesterol levels were higher in patients with transplant coronary artery disease (221 +/- 7.6 vs 191 +/- 9.2 mg/dl, p = 0.039). Serum triglycerides were also higher in patients with transplant coronary artery disease by angiography (246 +/- 38.3 vs 139 +/- 20.8 mg/dl, p = 0.050). Multivariate analysis identified t-PA antigen (p = 0.003) and triglyceride levels (p = 0.038) as independent predictors for the presence of transplant coronary artery disease. We conclude that cardiac transplant patients with evidence of transplant coronary artery disease on coronary angiography have altered hemostatic function which is reflected by elevated levels of circulating t-PA and PAI-1 antigens. The interaction of the hemostatic system and serum lipids in the development of transplant coronary artery disease warrants further study.
止血因子参与了原发性冠状动脉疾病的发病机制。然而，它们在移植后冠状动脉疾病中的作用尚不明确。为了评估止血因子在移植后冠状动脉疾病中的作用，我们对52例连续的心脏移植患者进行了研究。通过血管造影确定移植后冠状动脉疾病的存在。采用酶联免疫吸附测定法测定血浆组织型纤溶酶原激活物（t-PA）、纤溶酶原激活物抑制剂-1（PAI-1）、血管性血友病因子（vWF）和纤维蛋白D-二聚体的水平。采用酶法测定血脂。移植后冠状动脉疾病患者的循环t-PA水平较高（8.6±0.8 vs. 5.4±0.6 ng/ml，p = 0.021），PAI-1抗原浓度也较高（38.0±3.4 vs 25.8±2.2 ng/ml，p = 0.037）。t-PA和PAI-1抗原浓度与血管造影疾病的严重程度相关（t-PA的R = 0.34；p = 0.014，PAI-1的R = 0.45；p = 0.001）。移植后冠状动脉疾病患者的血清胆固醇水平较高（221±7.6 vs 191±9.2 mg/dl，p = 0.039）。通过血管造影发现，移植后冠状动脉疾病患者的血清甘油三酯水平也较高（246±38.3 vs 139±20.8 mg/dl，p = 0.050）。多变量分析确定t-PA抗原（p = 0.003）和甘油三酯水平（p = 0.038）是移植后冠状动脉疾病存在的独立预测因素。我们得出结论，冠状动脉造影显示有移植后冠状动脉疾病证据的心脏移植患者的止血功能发生了改变，这表现为循环t-PA和PAI-1抗原水平升高。止血系统与血脂在移植后冠状动脉疾病发生过程中的相互作用值得进一步研究。
