Patients with Antineutrophil Cytoplasmic Antibodies Associated Vasculitis in Remission Are Hypercoagulable
Patients with Antineutrophil Cytoplasmic Antibodies Associated Vasculitis in Remission Are Hypercoagulable
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DOI：
10.3899/jrheum.130200
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发表时间：
2013-12-01
影响因子：
3.9
通讯作者：
Tervaert, Jan Willem Cohen
中科院分区：
文献类型：
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作者：
Hilhorst, Marc;Winckers, Kristien;Tervaert, Jan Willem Cohen
目标。与健康受试者相比，抗中性粒细胞细胞质抗体（ANCA）相关血管增生（AAV）患者发生静脉血栓栓塞（VTE）的风险增加。静脉血栓栓塞发生率增加的机制尚不完全清楚。我们假设缓解期的AAV患者比健康对照者有更多的促凝剂。AAV缓解且过去6个月无静脉血栓栓塞的患者纳入研究。排除严重肾功能损害患者（血清肌酐> 250 mu mol/l）。包括年龄和性别匹配的健康对照。内源性凝血酶电位（ETP）与止血指标：纤维蛋白原、d -二聚体、因子VIII （FVIII）、组织因子通路抑制剂（TFPI）、蛋白C和游离蛋白s一起测定。纳入31例患者。在27例未服用抗凝药物的患者中，测量了ETP，发现ETP升高：137.1%，而健康对照组的中位数为90.0% （p < 0.01）。患者纤维蛋白原和d -二聚体水平未升高（中位数分别为35 g/l和279 μ g/l）。与健康对照组相比，患者的FVIII和TFPI水平也显著升高（分别为159%比137%；122.5%比101%），而蛋白C和游离蛋白S水平未升高（分别为126.5%比118.6%和124.6%比118.3%）。缓解期的AAV患者比健康对照组有更多的促凝剂，如ETP升高所示。在这些患者中测量到的FVIII水平升高表明内皮细胞持续激活和/或功能障碍。这种内皮功能障碍可能导致持续的低级别促凝状态。
Objectives. The risk of venous thromboembolism (VTE) is increased in patients with antineutrophil cytoplasmic antibodies (ANCA) associated vasculitides (AAV) as compared to healthy subjects. The mechanisms underlying this increased occurrence of VTE are not completely understood. We hypothesize that AAV patients in remission are more procoagulant than healthy controls.Methods. Patients with AAV in remission and no VTE for the last 6 months were included. Patients with severe renal impairment (serum creatinine > 250 mu mol/l) were excluded. Age and sex matched healthy controls were included. The endogenous thrombin potential (ETP) was determined together with hemostatic variables: fibrinogen, D-dimers, factor VIII (FVIII), tissue factor pathway inhibitor (TFPI), protein C, and free protein S.Results. Thirty-one patients were included. In 27 patients not taking anticoagulants, ETP was measured and found to be elevated: 137.1% as compared to a median of 90.0% for healthy controls (p < 0.01). Fibrinogen and D-dimer levels were not elevated in patients (median 35 g/l and 279 mu g/l, respectively). FVIII and TFPI levels were also significantly increased in patients as compared to healthy controls (159% vs 137%; 122.5% vs 101%, respectively), whereas protein C and free protein S levels were not elevated (126.5% vs 118.6% and 124.6% vs 118.3%, respectively).Conclusion. Patients with AAV in remission are more procoagulant than healthy controls, as indicated by an increased ETP. The increased FVIII level measured in these patients suggests persistence of endothelial activation and/or dysfunction. This endothelial dysfunction may cause a continuous low-grade procoagulant state.