Yamazumi K, Ojiro M, Okumura H, Aikou T
First Department of Surgery, Kagoshima University School of Medicine, Japan.
Am J Surg. 1998 Apr;175(4):297-301. doi: 10.1016/s0002-9610(98)00014-2.
Relationships between blood coagulation and the fibrinolysis system and morphology of aneurysms in patients with abdominal aortic aneurysm (AAA) are unknown.
Preoperative and postoperative evaluations of hemostatic factors such as thrombin-antithrombin III complex (TAT), D-dimer, fibrinogen/fibrin degradation products (FDP), and platelet count were performed in 36 patients with atherosclerotic AAA. As control subjects, 25 age- and sex-matched healthy volunteers were analyzed for these hemostatic factors. In all patients, morphological evaluation of AAA included the largest diameter, tortuosity, and the thickness of intraluminal thrombus to be compared with preoperative levels of hemostatic factors such as alpha-2 plasmin inhibitor-plasmin complex (PIC), thrombomodulin (TM), von Willebrand factor (vWF), tissue factor (TF), and free form of tissue factor pathway inhibitor (F-TFPI).
The preoperative values of TAT, D-dimer, and FDP were significantly higher in AAA patients than in controls. Of all patients, 23 (64%) or 22 (58%) had TAT or D-dimer values greater than 8.2 ng/mL or 3.4 microg/mL (mean + 2SD of controls), respectively. The postoperative values of these hemostatic factors significantly improved, but were not normalized. The largest diameter of AAA correlated with the preoperative levels of TAT (r = 0.566, P = 0.001), D-dimer (r = 0.644, P = 0.0001), FDP (r = 0.561, P = 0.0009), PIC (r = 0.413, P = 0.0146), and F-TFPI (r = 0.408, P = 0.0158). We have also found that tortuosity of AAA has relation not only to the preoperative levels of fibrinolytic factors but also to the plasma F-TFPI antigen levels. On the other hand, the preoperative levels of a marker of endothelial damage, such as TM or vWF, and TF did not correlate with those of F-TFPI in all patients. The maximum thickness of thrombus in AAA significantly correlated not only with the preoperative levels of TAT, D-dimer, FDP, and PIC, but also with AAA size.
We have found evidence that an activated state of both blood coagulation and fibrinolysis in AAA patients is associated with the morphological characteristics of aneurysms.
腹主动脉瘤（AAA）患者的凝血与纤溶系统之间的关系以及动脉瘤的形态尚不清楚。
对36例动脉粥样硬化性AAA患者进行术前和术后凝血因子评估，如凝血酶 - 抗凝血酶III复合物（TAT）、D - 二聚体、纤维蛋白原/纤维蛋白降解产物（FDP）和血小板计数。作为对照，对25名年龄和性别匹配的健康志愿者进行这些凝血因子分析。对所有患者的AAA进行形态学评估，包括最大直径、迂曲度和腔内血栓厚度，并与术前凝血因子水平如α-2纤溶酶抑制剂 - 纤溶酶复合物（PIC）、血栓调节蛋白（TM）、血管性血友病因子（vWF）、组织因子（TF）和游离形式的组织因子途径抑制剂（F - TFPI）进行比较。
AAA患者术前TAT、D - 二聚体和FDP值显著高于对照组。所有患者中，分别有23例（64%）或22例（58%）的TAT或D - 二聚体值高于8.2 ng/mL或3.4 μg/mL（对照组均值 + 2SD）。这些凝血因子的术后值显著改善，但未恢复正常。AAA的最大直径与术前TAT水平（r = 0.566，P = 0.001）、D - 二聚体（r = 0.644，P = 0.0001）、FDP（r = 0.561，P = 0.0009）、PIC（r = 0.413，P = 0.0146）和F - TFPI（r = 0.408，P = 0.0158）相关。我们还发现AAA的迂曲度不仅与术前纤溶因子水平有关，还与血浆F - TFPI抗原水平有关。另一方面，在所有患者中，内皮损伤标志物如TM或vWF以及TF的术前水平与F - TFPI的水平无相关性。AAA中血栓的最大厚度不仅与术前TAT、D - 二聚体、FDP和PIC水平显著相关，还与AAA大小相关。
我们发现证据表明AAA患者凝血和纤溶的激活状态与动脉瘤的形态特征相关。
