Serial changes in von Willehrand factor-cleaving protease (ADAMTS13) and prognosis after acute myocardial infarction
Serial changes in von Willehrand factor-cleaving protease (ADAMTS13) and prognosis after acute myocardial infarction
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DOI：
10.1016/j.amjcard.2007.03.095
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发表时间：
2007-09-01
影响因子：
2.8
通讯作者：
Ogawa, Hisao
中科院分区：
文献类型：
--
作者：
Matsukawa, Masakazu;Kaikita, Koichi;Ogawa, Hisao
血管性血友病因子（VWF）是血小板粘附和聚集的辅助因子，可增加止血和血栓形成。最近，已经鉴定了切割VWF多聚体的金属蛋白酶，即ADAMTS 13。本研究旨在探讨急性心肌梗死（AMI）后血浆VWF和ADAMTS 13的动态变化与预后的关系。本文测定了92例急性心肌梗死患者和40例正常对照者血浆VWF和ADAMTS 13抗原水平的动态变化。AMI患者入院时VWF水平显著高于对照组（p < 0.01），入院后3天达到峰值，并持续14天。相比之下，入院时，AMI患者的ADAMTS 13水平显着低于对照组（p < 0.0001），3天后达到最低抗原水平，并在14天内保持较低水平。AMI患者VWF/ADAMTS 13抗原水平的比值在整个时间过程中均高于对照组。考克斯风险分析显示，早期VWF和VWF/ADAMTS 13比值水平升高和早期ADAMTS 13水平降低是1年随访期间未来血栓形成事件的显著预测因素。Kaplan-Meier分析表明，ADAMTS 13水平显著降低和VWF/ADAMTS 13水平显著升高的患者发生血栓形成事件的概率显著更高（分别为p = 0.0104和0.0209）。结论：早期监测AMI患者VWF和ADAMTS 13抗原水平的变化，对预测和预防AMI患者1年随访期间血栓形成具有重要意义。(C)2007年爱思唯尔公司All rights reserved.
Von Willebrand factor (VWF), a cofactor in platelet adhesion and aggregation, increases hemostasis and thrombosis. Recently, a metalloprotease that cleaves VWF multimers has been identified, namely ADAMTS13. The aim of this study was to investigate the relation between serial changes in plasma VWF and ADAMTS13 and the prognosis after acute myocardial infarction (AMI). We measured serial changes of plasma VWF and ADAMTS13 antigen levels in 92 patients with AMI and 40 control subjects. VWF levels were significantly higher in patients with AMI compared with controls (p < 0.01) on admission, peaked 3 days after admission, and remained high for 14 days. In contrast, on admission, ADAMTS13 levels were significantly lower in patients with AMI compared with controls (p < 0.0001), with minimum antigen levels reached after 3 days, and remained lower for 14 days. The ratio of VWF/ADAMTS13 antigen levels was higher in patients with AMI compared with controls throughout the time course. Cox hazards analysis revealed that the early increase of VWF and VWF/ADAMTS13 ratio levels and the early decrease of ADAMTS13 levels were significant predictors of future thrombotic events during the 1-year follow-up period. Kaplan-Meier analysis demonstrated that patients with major decreases of ADAMTS13 levels and high increases of VWF/ADAMTS13 levels had significantly greater probabilities for development of thrombotic events (p = 0.0104 and 0.0209, respectively). In conclusion, these findings suggest that monitoring the changes of VWF and ADAMTS 13 antigen levels in the early phase might be valuable for predicting and preventing thrombosis during 1-year follow-up in patients with AMI. (C) 2007 Elsevier Inc. All rights reserved.