Relationship between coagulation cascade, cytokine, adhesion molecule and aortic aneurysm
Relationship between coagulation cascade, cytokine, adhesion molecule and aortic aneurysm
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DOI：
10.1016/s1010-7940(03)00156-8
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发表时间：
2003-06-01
影响因子：
3.4
通讯作者：
Ihara, K
中科院分区：
文献类型：
--
作者：
Nomura, F;Ihara, A;Ihara, K
目的：主动脉瘤（AA）患者处于慢性炎症状态，常合并弥散性血管间凝血。近年来的研究表明动脉粥样硬化是一种炎症性疾病。AA和严重动脉粥样硬化伴溃疡形成含有巨噬细胞和T淋巴细胞，并加速白细胞介素（IL）-2的产生，从而激活淋巴细胞并导致白细胞进一步粘附。本研究旨在阐明AA患者的凝血状态、细胞因子、粘附分子和胶原更新，并最终阐明它们与动脉瘤大小的关系。研究方法：17例AA患者（平均年龄：72.2岁）术前进行CT检查时，测定凝血酶-抗凝血酶III复合物（达特）、血浆D-二聚体、血清III型前胶原肽（PIIIP）、血清可溶性IL-2受体（sIL-2 R）、游离组织因子途径抑制物（TFPI）和可溶性细胞间粘附分子（ICAM-1）。年龄匹配（平均年龄：70岁）的志愿者作为对照。通过CT测量动脉瘤的最大尺寸，并通过CT计算动脉瘤体积。结果如下：AA患者术前达特和D-二聚体水平显著高于对照组（达特：对照组2.5 +/- 1.2 ng/ml，前7.2 +/- 4.5，ng/ml; P = 0.0001; D-二聚体：对照组107 +/- 46 U/ml，前420 +/- 256 U/ml; P = 0.0001）。术前细胞因子水平也较高（sIL-2 R：对照组398 +/- 132 U/ml，前组735 +/- 260 U/ml; P 0.0001）。术前TFPI值较高（对照组22.9 +/- 4.9 ng/ml，术前30.4 +/- 6.9 ng/ml; P = 0.003）。PIIIP（胶原转换）显示组间无差异（P = 0.0057），ICAM-1也无差异（P = 0.0087）。达特（r = 0.799，P 0.0001），D-二聚体（r = 0.56，P = 0.0193），sIL-2R（r = 0.709，P = 0.0021），PIIIP（r = 0.561，P = 0.00239），与sICAM-1（r = 0.505，P = 0.046）与主动脉瘤大小、达特D-二聚体呈正相关，sIL-2 R水平与胆囊体积呈正相关（r = 0.714 P = 0.0013，r = 0.556 P = 0.00204，r = 0.693 P = 0.0029）。结论：AA患者处于高凝状态和炎症状态。达特、D-二聚体、sIL-2 R、PHIP、sICAM-1与动脉瘤大小相关，提示这些指标可作为诊断和监测疾病进展的良好工具。(C)2003 Elsevier Science B. V.保留所有权利。
Objectives: Patients with aortic aneurysm (AA) were in the chronic inflammatory condition and are often combined with disseminated intervascular coagulation. Recent studies demonstrated that atherosclerosis was inflammatory disease. AA and severe atherosclerosis with ulcer formation contain macrophages and T lymphocytes and accelerate the production of interleukin (IL)-2, which activates lymphocytes and lead to further adhesion of leukocytes. This study was designed to clarify the coagulation condition, cytokine, adhesion molecule, and collagen turnover in patients with AA and finally their relationship with the aneurysmal size. Methods: Thrombin-antithrombin III complex (TAT), plasma D-dimer, serum type III procollagen peptide (PIIIP), serum soluble IL-2 receptor (sIL-2R), Free tissue factor pathway inhibitor (TFPI), and soluble intercellular adhesion molecule (ICAM-1) were measured preoperatively around the same period when computed tomography (CT) was taken in 17 patients with AA (mean age: 72.2 years). Age-matched (mean age:70 years) volunteers were served as control. Maximum aneurysmal size was measured by CT and aneurysmal volume was also calculated from CT. Results: AA patients showed significantly higher level in preoperative TAT and D-dimer compared to control (TAT: control 2.5 +/- 1.2 ng/ml, pre 7.2 +/- 4.5, ng/ml; P = 0.0001; D-dimer: control 107 +/- 46 U/ml, pre 420 +/- 256 U/ml; P = 0.0001). Cytokine also showed higher level preoperatively (slL-2R: control 398 +/- 132 U/ml, pre 735 +/- 260 U/ml; P 0.0001). TFPI showed higher value preoperatively (control 22.9 +/- 4.9 ng/ml, pre 30.4 +/- 6.9 ng/ml; P = 0.003). PIIIP (collagen turnover) showed no difference between the groups (P = 0.0057) and neither did ICAM-1 (P = 0.0087). TAT (r = 0.799, P 0.0001), D-dimer (r = 0.56, P = 0.0193), sIL-2R (r = 0.709, P = 0.002 1), PIIIP (r = 0.561, P = 0.00239), and sICAM-1 (r = 0.505, P = 0.046) level showed positive correlation with aortic aneurysmal size and also TAT D-dimer, and sIL-2R levels were positively correlated with aneurysmal volume (r = 0.714 P = 0.0013, r = 0.556 P = 0.00204, r = 0.693 P = 0.0029, respectively). Conclusions: AA patients were in the hypercoagulation and inflammatory condition. Aneurysmal size was well correlated with TAT, D-dimer, sIL-2R, PHIP, and sICAM-1, suggesting that these markers could be good diagnostic and monitoring tool for the disease progression. (C) 2003 Elsevier Science B.V. All rights reserved.