HEMOSTATIC FUNCTION AND ARTERIAL-DISEASE
HEMOSTATIC FUNCTION AND ARTERIAL-DISEASE
复制标题
DOI：
10.1093/oxfordjournals.bmb.a072924
复制
发表时间：
1994-10-01
影响因子：
6.7
通讯作者：
MEADE, TW
中科院分区：
文献类型：
--
作者：
MEADE, TW
对缺血性心脏病(IHD)血栓成分的普遍认识是相对较新的。尽管血小板的作用很明显，但它在许多方面--当然也是在流行病学上--是对凝血系统的研究，在表征那些由于止血异常而处于IHD高危人群方面更有成效。血浆纤维蛋白原水平升高明显且独立地与临床表现的IHD和卒中的发病有关，也可能与下肢动脉疾病有关。高纤维蛋白原水平也会增加复发率和这些疾病的进展。因子VII的高活性水平与IHD死亡率的增加有关，但与非致命性发作无关。纤溶活性低和第VIII因子水平升高也与IHD发生率增加有关。高纤维蛋白原水平通过影响粘度、血小板聚集性、纤维蛋白沉积和动脉粥样硬化过程而易于血栓形成。越来越多的证据表明，凝血因子VII活性水平的提高会导致凝血酶产生的增加。几种个人特征的关联--尤其是在纤维蛋白原情况下的吸烟和在第七因子活性情况下的饮食脂肪摄入--以可能导致血栓形成的方式影响凝血系统。除了众所周知的阿司匹林和抗凝剂外，现在应该更多地关注纤维蛋白原降低剂的抗血栓潜力。
General recognition of the thrombotic component in ischaemic heart disease (IHD) is comparatively recent. Despite the obvious role of platelets, it has in many ways - and certainly epidemiologically - been work on the coagulation system that has been more rewarding in characterising those at high risk of IHD on account of haemostatic abnormalities. Raised plasma fibrinogen levels are clearly and independently associated with the onset of both clinically manifest IHD and stroke and probably with lower extremity arterial disease as well. High fibrinogen levels also increase recurrence rates and the progression of these conditions. High factor VII activity levels are associated with increased mortality from IHD but not with non-fatal episodes. Low fibrinolytic activity and raised factor VIII levels are also associated with increased IHD incidence. High fibrinogen levels predispose to thrombosis by effects on viscosity, platelet aggregability, fibrin deposition and the atherogenic process. There is increasing evidence that raised factor VII activity levels lead to increased thrombin production. Associations of several personal characteristics - notably smoking in the case of fibrinogen and dietary fat intake in the case of factor VII activity - influence the coagulation system in ways that are likely to predispose to thrombosis. Besides well known agents such as aspirin and anticoagulants, increasing attention ought now to be given to the antithrombotic potential of fibrinogen-lowering agents.