Increased inflammation and endothelial markers in patients with late severe post-thrombotic syndrome
Increased inflammation and endothelial markers in patients with late severe post-thrombotic syndrome
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DOI：
10.1371/journal.pone.0227150
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发表时间：
2020-01-16
期刊：
影响因子：
3.7
通讯作者：
Annichino-Bizzacchi, Joyce Maria
中科院分区：
文献类型：
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作者：
Bittar, Luis Fernando;da Silva, Leticia Queiroz;Annichino-Bizzacchi, Joyce Maria
血栓形成后综合征（PTS）是20-50%下肢深静脉血栓形成（DVT）患者存在的限制性长期并发症。研究了一组具有潜在相关性的生物标志物，以提高对PTS病理生理学的认识。方法本病例-对照研究纳入93例下肢深静脉血栓患者，其中31例为重度PTS（病例），62例为轻度/无PTS（对照组），急性发作后24个月。31名没有深静脉血栓病史的健康个体（HI）被纳入作为参考人群。评估FVIII活性、d -二聚体、炎症因子、内皮功能障碍标志物、基质金属蛋白酶及其抑制剂、组织重塑和生长因子水平。PTS的分类采用Villalta量表。结果与轻度/无PTS患者相比，重度PTS患者CRP、sICAM-1、se -选择素水平升高，MMP-9和MCP-1水平降低。此外，与HI相比，DVT患者的FVIII和d -二聚体水平更高。结论深静脉血栓患者在急性血栓发作后很长一段时间内仍存在炎症状态、内皮功能障碍和蛋白水解MMPs活性改变，这在重症PTS中更为明显。这些结果提示这些介质可能在PTS严重程度的维持和恶化中起作用。
IntroductionPost-thrombotic syndrome (PTS) is a limiting long-term complication present in 20-50% of patients with deep venous thrombosis (DVT) of the lower limbs. A panel of biomarkers with potential relevance to enhance knowledge on the pathophysiology of PTS was investigated.MethodsThis case-control study included 93 patients with DVT in the lower limbs, 31 with severe PTS (cases) and 62 with mild/no PTS (controls), over 24 months after an acute episode. Thirty-one healthy individuals (HI) with no history of DVT were included as a reference to the population. FVIII activity, D-dimer, inflammatory cytokines, endothelial dysfunction markers, matrix metalloproteinases, and their inhibitors, tissue remodeling and growth factor levels were evaluated. The classification of PTS was, by the Villalta scale.ResultsPatients with severe PTS showed elevated levels of CRP, sICAM-1, sE-selectin, and decreased MMP-9 and MCP-1 levels when compared to patients with mild/no PTS. Moreover, DVT patients presented higher levels of FVIII and D-dimer when compared to HI.ConclusionsDVT patients present an inflammatory status, endothelial dysfunction and altered proteolysis MMPs activity, even a long time after the acute thrombotic episode, which is more significant in severe PTS. These results suggest a possible role of these mediators in the maintenance and worsening of PTS severity.