Increased platelet, leukocyte, and endothelial cell activity are associated with increased coagulability in patients after total knee arthroplasty
Increased platelet, leukocyte, and endothelial cell activity are associated with increased coagulability in patients after total knee arthroplasty
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DOI：
10.1111/j.1538-7836.2007.02443.x
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发表时间：
2007-04-01
影响因子：
10.4
通讯作者：
Mizobe, T.
中科院分区：
文献类型：
--
作者：
Kageyama, K.;Nakajima, Y.;Mizobe, T.
背景资料：骨科手术，特别是全膝关节和全髋关节置换术，被认为是围手术期静脉血栓栓塞的风险因素。目的：本研究评估了如何加速致炎性细胞相互作用和随后的组织因子和CD 40配体的产生在静脉血栓栓塞症的发病机制中发挥重要作用。患者和方法：24例接受全膝关节置换术的患者被随机分配到充气止血带充气组（Ti; n = 12）和未充气止血带充气组（Tn; n = 12）。结果如下：Ti组患者围手术期外周血白细胞-血小板聚集体，尤其是单核细胞-血小板聚集体明显升高（P < 0.01），术后24 h恢复至术前水平。Ti组中心静脉血中PAC-1、P-选择素、CD 40配体、组织因子、单核细胞（包括单核-血小板聚集体）上Mac-1表达水平以及微粒（包括内皮细胞来源的微粒）数量显著增加（P < 0.01）。钛组中心静脉血的全血凝固性也明显升高（P < 0.01）。静脉血浆组织因子抗原、CD 40配体、血小板第4因子、β-血小板球蛋白、可溶性纤维蛋白单体复合物和凝血酶原片段1+2浓度也升高（P < 0.05）。结论：本研究表明，在全膝关节置换术的围手术期，血小板、白细胞和内皮细胞的活性以及它们之间的相互作用增强，特别是在下半身的静脉血中，这因此增强了血液的凝固性。此外，手术期间止血带充气会夸大这些反应。
Background: Orthopedic surgery, especially total knee and total hip arthroplasty, is considered a risk factor for peri-operative venous thromboembolism. Objectives: This study evaluates how accelerated inflammatogenic cellular interactions and the subsequent production of tissue factor and CD40 ligand play an important role in the pathogenesis of venous thromboembolism. Patients and methods: Twenty-four patients undergoing total knee arthroplasty were randomly assigned to groups with (Ti; n = 12) and without (Tn; n = 12) pneumatic tourniquet inflation. Results: Numbers of leukocyte-platelet aggregates, especially those comprising monocytes-platelets in central venous blood from the Ti group, were increased during the peri-operative period (P < 0.01), and returned to the baseline level at 24 h after starting surgery. Levels of PAC-1, P-selectin, CD40 ligand, tissue factor, Mac-1 expression on monocytes including monocyte-platelet aggregates, and the number of microparticles including those of endothelial cell origin were noticeably increased in central venous blood from the Ti group (P < 0.01). Whole blood coagulability was also obviously increased in central venous blood from the Ti group (P < 0.01). Furthermore, the concentrations of venous plasma tissue factor antigen, CD40 ligand, platelet factor 4, beta-thromboglobulin, the soluble fibrin monomer complex and prothrombin fragment 1+2 were also increased (P < 0.05). Conclusions: This study showed that platelet, leukocyte and endothelium activities as well as their interactions are enhanced during the peri-operative period of total knee arthroplasty, particularly in venous blood from the lower half of the body, which consequently augments blood coagulability. Further, tourniquet inflation during surgery exaggerates these responses.