Changes in coagulation-fibrinolysis marker and neutrophil elastase following the use of tourniquet during total knee arthroplasty and the influence of neutrophil elastase on thromboembolism
Changes in coagulation-fibrinolysis marker and neutrophil elastase following the use of tourniquet during total knee arthroplasty and the influence of neutrophil elastase on thromboembolism
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DOI：
10.1111/j.1399-6576.2005.00621.x
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发表时间：
2005-04-01
影响因子：
2.1
通讯作者：
Yoshino, S
中科院分区：
文献类型：
--
作者：
Katsumata, S;Nagashima, M;Yoshino, S
为了详细阐明深静脉血栓形成（DVT）和/或肺血栓栓塞（PTE）发生和加重的机制，我们重点关注以下因素：凝血酶-抗凝血酶III复合物（达特）、D-二聚体和中性粒细胞弹性蛋白酶（NE）。本研究主要探讨NE在PTE Ⅰ a小鼠模型形成中的作用。19例类风湿性关节炎（RA）和6例骨关节炎（OA）患者行带止血带的全膝关节置换术（TKA），13例RA和12例OA患者行不带止血带的TKA。分别于术前、术后即刻及术后1天内检测血达特、D-二聚体和NE水平。应用二磷酸腺苷（ADP）诱导血小板聚集性PTE，同时应用人NE和ADP诱导DVT和/或PTE，术后止血带组达特、D-二聚体和NE的平均升高率明显高于未止血带组。与单次ADP给药相比，ADP和人NE给药后，PTE导致的小鼠死亡率从43%增加至67%。在接受NE和ADP注射的小鼠的肺组织学变化的特点是肺泡毛细血管和其他microvessels.We的血小板和纤维蛋白的弥漫性和广泛的积累，在TKA，止血带的使用诱导局部释放大量的NE从中性粒细胞，诱导DVT和/或PTE的发展及其恶化。
To clarify in detail the mechanism underlying the development and exacerbation of deep venous thrombosis (DVT) and/or pulmonary thromboembolism (PTE), we focused on the following factors: the thrombin-antithrombin III complex (TAT), D-dimer and neutrophil elastase (NE). We basically investigated whether NE played an important role in the development of PTE I a mice model.Nineteen rheumatoid arthritis (RA) and six osteoarthritis (OA) patients underwent total knee arthroplasty (TKA) with tourniquet, and 13 RA and 12 OA patients underwent TKA without tourniquet in each group. The blood levels of TAT, D-dimer and NE were measured before surgery, immediately after and during the days following surgery. For the induction of experimental PTE due to coagulation of platelets, adenosine diphosphate (ADP) was administrated, and human NE with ADP was also administrated for the development of DVT and/or PTE.The rates of increase in the mean TAT, D-dimer and NE levels in the group with tourniquet were statistically higher than those in the group without tourniquet after surgery. The mortality of the mouse due to PTE increased from 43 to 67% following ADP and human NE administration compared to a single ADP administration. Histological changes of the lungs in the mice receiving NE and ADP injections were characterized by a diffuse and extensive accumulation of platelets and fibrin in alveolar capillaries and other microvessels.We suggest that during TKA, the use of tourniquet induces local release of a large amount of NE from neutrophils, inducing the development of DVT and/or PTE and their exacerbation.