Balance between von Willebrand factor and ADAMTS13 following major partial hepatectomy
Balance between von Willebrand factor and ADAMTS13 following major partial hepatectomy
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DOI：
10.1002/bjs.10107
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发表时间：
2016-05-01
影响因子：
9.6
通讯作者：
Lisman, T.
中科院分区：
文献类型：
--
作者：
Groeneveld, D. J.;Alkozai, E. M.;Lisman, T.
背景：肝手术后常规凝血检查经常延长，提示术后出血倾向。同时，肝部分切除术（PH）后的血栓性并发症并不少见。对于PH后血小板粘附蛋白血管性血友病因子（VWF）及其切割蛋白酶（一种具有血小板反应蛋白1型基元的崩解素和金属蛋白酶13 （ADAMTS13）成员）的变化知之甚少。方法：收集PH和保幽门胰十二指肠切除术（PPPD）前后和24名健康个体的血浆样本。测定各组血浆VWF和ADAMTS13水平、VWF活性和VWF依赖性血小板粘附性，并进行比较。结果：中位数（i.q.）PH（17例）后VWF水平比PPPD（10例）后增加更多，在术后一天（POD）达到最高水平(570（473-656）对354 (305- 476%)；P = 0.009)。在POD30上，VWF水平仍然升高。中位数（智商）下降。在两组患者中均观察到ADAMTS13活性，在POD7中达到最低水平(24%(16- 32%)，而PH和PPPD分别为38% (23- 66%)；P = 0.049)，并且在POD30时水平仍显著降低。与PPPD相比，PH后第7天VWF活性显著升高（中位数（i.q.））。分别为517（440-742）和385 (322- 4884)；P = 0.009)，并在POD30时保持升高。PH和PPPD后，血流条件下vwf依赖性血小板粘附增加至POD30，但PH组更明显。结论：PH和PPPD患者VWF和ADAMTS13水平及活性的平衡均有改变。PH后VWF-ADAMTS13轴的变化比PPPD后更明显，持续时间更长。
Background: Conventional coagulation tests are frequently prolonged after liver surgery, suggesting a postoperative bleeding tendency. At the same time, thrombotic complications following partial hepatectomy (PH) are not uncommon. Little is known about changes in the platelet adhesive protein von Willebrand factor (VWF) and its cleaving protease a disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13 (ADAMTS13) following a PH.Methods: Plasma samples were collected before and after PH and pylorus-preserving pancreaticoduodenectomy (PPPD), and from 24 healthy individuals. Plasma levels of VWF and ADAMTS13, VWF activity and VWF-dependent platelet adhesion were measured, and compared between the groups.Results: Median (i.q.r.) VWF levels increased more after PH (17 patients) than following PPPD (10), reaching the highest level on postoperative day (POD) 3 (570 (473-656) versus 354 (305-476) per cent respectively; P = 0.009). VWF levels remained raised on POD30. A decrease in median (i.q.r.) ADAMTS13 activitywas observed for both patient groups, reaching the lowest level on POD7 (24 (16-32) versus 38 (23-66) per cent for PH and PPPD respectively; P = 0.049), and levels remained significantly reduced at POD30. VWF activity was significantly higher on day 7 following PH compared with PPPD (median (i.q.r.) 517 (440-742) versus 385 (322-484) per cent respectively; P = 0.009), and remained increased at POD30. VWF-dependent platelet adhesion under conditions of flow was increased until POD30 in patients after PH and PPPD, but was more pronounced in the PH group.Conclusion: There are changes in the balance between VWF and ADAMTS13 levels and activity in patients after both PH and PPPD. Changes in the VWF-ADAMTS13 axis were more pronounced and of longer duration after PH than following PPPD.