Heinemann L A, Assmann A, Spannagl M, Schramm W, Dick A, Kluft C, de Maat M P
ZEG-Centre for Epidemiology and Health Research, Zepernick, Germany.
Contraception. 1998 Nov;58(5):321-2. doi: 10.1016/s0010-7824(98)00111-5.
Recently, discussions focused on the question whether acquired activated (APC) resistance is a clue to the observed association between venous thromboembolism (VTE) risk and oral contraceptive (OC) use, especially with the so-called third-generation OC. The objective of our study was to check the validity of acquired APC resistance regarding VTE risk in a case-control study. Sixty-seven women with confirmed VTE diagnosis (n = 67) were consecutively ascertained in primary health care settings, interviewed and blood samples taken (at the earliest 6 months after VTE). Cases were age-matched to 290 population controls. Acquired APC resistance was measured as normalized APC ratio (APCRN). The effect of APC on tissue factor initiated thrombin generation was measured in plasma using alpha 2-macroglobulin attached thrombin activity as an endpoint. Higher risk (odds) ratio with 95% CI) of VTE for carriers of heterozygote Factor V Leiden mutation was confirmed [OR = 2.72 (CI:1.51-4.92)]. However, there is no association between VTE and the level of APCRN OR 0.65 (CI:0.35-1.22). We conclude that acquired APC resistance, measured with a tissue factor initiated test, is unlikely to have a direct association to the clinical outcome of venous thromboembolism.
最近，讨论集中在获得性活化蛋白C（APC）抵抗是否是观察到的静脉血栓栓塞（VTE）风险与口服避孕药（OC）使用之间关联的线索这一问题上，尤其是与所谓的第三代OC相关。我们研究的目的是在一项病例对照研究中检验获得性APC抵抗与VTE风险之间关系的有效性。在初级卫生保健机构中连续确定了67例确诊为VTE的女性（n = 67），对她们进行了访谈并采集了血样（在VTE发生后最早6个月）。病例与290名人群对照进行年龄匹配。获得性APC抵抗通过标准化APC比值（APCRN）来衡量。使用附着α2 -巨球蛋白的凝血酶活性作为终点，在血浆中测量APC对组织因子启动的凝血酶生成的影响。杂合子因子V莱顿突变携带者发生VTE的风险（优势）比及95%置信区间得到确认[比值比 = 2.72（置信区间：1.51 - 4.92）]。然而，VTE与APCRN水平之间无关联，比值比为0.65（置信区间：0.35 - 1.22）。我们得出结论，用组织因子启动试验测量的获得性APC抵抗不太可能与静脉血栓栓塞的临床结局有直接关联。
