EXTRAVASCULAR FIBRIN FORMATION AND DISSOLUTION IN SYNOVIAL TISSUE OF PATIENTS WITH OSTEOARTHRITIS AND RHEUMATOID-ARTHRITIS
EXTRAVASCULAR FIBRIN FORMATION AND DISSOLUTION IN SYNOVIAL TISSUE OF PATIENTS WITH OSTEOARTHRITIS AND RHEUMATOID-ARTHRITIS
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DOI：
10.1002/art.1780340809
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发表时间：
1991-08-01
影响因子：
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通讯作者：
GREENBERG, CS
中科院分区：
文献类型：
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作者：
WEINBERG, JB;PIPPEN, AMM;GREENBERG, CS
类风湿性关节炎（RA）患者滑膜中纤维蛋白沉积是一个突出的发现。在RA滑膜中发现数量增加的巨噬细胞，已知这些细胞产生多种促凝血和抗凝分子。使用免疫组织学技术，在RA，骨关节炎（OA），或创伤性关节异常需要手术的患者的滑膜凝血系统的几个重要组成部分的内容和分布进行了研究。对每个类别的3名患者的样本进行了详细检查。RA滑膜（与OA或关节创伤患者相比）的巨噬细胞数量增加，纤维蛋白原、组织因子、因子XIII、组织转氨酶、交联纤维蛋白（纤维蛋白D二聚体）、尿激酶型纤溶酶原激活剂和α-2-纤溶酶抑制剂的表达/含量增加。RA滑膜中的巨噬细胞含量在衬里细胞区和间质细胞区均增加。纤维蛋白原分布在整个组织中的所有样本，并在RA滑膜更大。在创伤和OA滑膜中，组织因子仅与血管（内皮细胞）相关，但在RA滑膜中，组织因子在整个组织中显著增加。虽然在创伤和OA滑膜的滑膜衬里细胞区域中观察到少量纤维蛋白D二聚体，但在RA滑膜的衬里细胞和间质细胞区域中存在增加的量。因子XIII和组织转氨酶在创伤和OA滑膜中含量很少，但在血管、衬里细胞和间质细胞区域的RA滑膜中两者（尤其是组织转氨酶）含量增加。RA滑膜中尿激酶和α-2-纤溶酶抑制剂也明显增加。这些结果表明，在发炎的滑膜中，存在与炎症程度和巨噬细胞含量相关的持续的血管外组织纤维蛋白形成和溶解。RA的血管外凝血/纤维蛋白溶解是这种疾病治疗干预的潜在靶点。
Fibrin deposition is a prominent finding in the synovium of patients with rheumatoid arthritis (RA). Macrophages are found in increased numbers in RA synovium, and these cells are known to produce a variety of procoagulant and anticoagulant molecules. Using immunohistologic techniques, the content and distribution of several important components of the coagulation system in the synovium of patients with RA, osteoarthritis (OA), or traumatic joint abnormalities requiring surgery were investigated. Samples from 3 patients from each category were examined in detail. RA synovium (compared with that of patients with OA or joint trauma) had increased numbers of macrophages and increased expression/content of fibrinogen, tissue factor, factor XIII, tissue transglutaminase, cross-linked fibrin (fibrin D dimer), urokinase-type plasminogen activator, and alpha-2-plasmin inhibitor. Macrophage content in RA synovium was increased in both the lining cell areas and the interstitial cell areas. Fibrinogen was distributed throughout the tissue in all samples and was greater in RA synovium. In trauma and OA synovia, tissue factor was seen only in association with vessels (endothelial cells), but in RA synovium, it was markedly increased throughout the tissues. While fibrin D dimer was seen in small amounts in synovial lining cell areas of trauma and OA synovia, it was present in increased amounts in the lining cell and interstitial cell areas of RA synovium. Factor XIII and tissue transglutaminase were present in scant amounts in trauma and OA synovia, but there were increased amounts of both (especially tissue transglutaminase) in RA synovium in the vessel, lining cell, and interstitial cell areas. Urokinase and alpha-2-plasmin inhibitor were also markedly increased in RA synovium. These results suggest that in inflamed synovium, there is ongoing extravascular tissue fibrin formation and dissolution that correlates with the degree of inflammation and macrophage content. Extravascular coagulation/fibrinolysis in RA represents a potential target for therapeutic intervention in this disease.