Brain regulation of thrombosis and hemostasis: from theory to practice.
Brain regulation of thrombosis and hemostasis: from theory to practice.
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DOI：
10.1161/strokeaha.113.000736
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发表时间：
2013-11
期刊：
影响因子：
8.3
通讯作者：
Fisher MJ
中科院分区：
文献类型：
--
作者：
Fisher MJ
全身血栓前状态的局灶性改变在静脉、动脉和微血管疾病中很明显。这一焦点似乎有双重基础，在于抗凝剂和促凝血因子在血管树的不同元素中的不同表达，以及不同器官的特定作用。6例如，内皮蛋白C受体(EPCR)主要在大动脉和静脉中表达，而TFPI主要在毛细血管中表达。6、7其他内皮依赖性抗凝剂(如一氧化氮)和促凝血剂(血管性血友病因子)分子分别对动脉和静脉表现出偏好。动脉血栓尤其依赖于血管完整性的丧失，从而导致内皮下表面暴露于血液中。6然而，冠状动脉血栓闭塞并不会因蛋白C、蛋白S或抗凝血酶III途径的缺陷而显著增加。相反，这些相同因素的缺乏明显易导致静脉血栓形成。5、6这些静脉血栓往往发生在静脉瓣膜袋部位的下肢，在那里血流停滞和局部缺氧是常见的。6、9在真性红细胞增多症、阵发性睡眠性血红蛋白尿和原发性血小板增多症中，血栓形成的分布有很大的不同
Focal changes in the presence of a systemic prothrombotic state are evident in diseases of veins, arteries, and microvessels. There seems to be a dual basis for this focality, residing in the differential expression of anticoagulant and procoagulant factors within different elements of the vascular tree, along with specific effects of different organs. 6 For example, the endothelial protein C receptor (EPCR) is expressed predominantly in large arteries and veins, whereas TFPI is principally in capillaries. 6, 7 Other endothelial-dependent anticoagulant (eg, nitric oxide) and procoagulant (von Willebrand factor) molecules show predilection for arteries and veins, respectively. 6, 8Arterial thromboses are particularly dependent on loss of vascular integrity with consequent exposure of subendothelial surfaces to blood. 6 Nevertheless, thrombotic occlusion of the coronary arteries does not substantially increase with deficiencies of the protein C, protein S, or antithrombin III pathway. 5 On the contrary, deficiencies of these same factors clearly predispose to venous thrombosis. 5, 6 These venous thromboses tend to occur in the lower extremities, at sites of venous valve pockets where stagnation of flow and local hypoxia are common. 6, 9 A vastly different distribution of thrombosis occurs in the presence of polycythemia vera, paroxysmal nocturnal hemoglobinuria, and essential thrombocythemia, in which