The values of TF, TFPI, and platelet aggregability in acute coronary syndromes

急性冠脉综合征(ACS)患者高凝状态与组织因子(TF)表达有关。组织因子途径抑制物(TFPI)调节组织因子途径介导的外源性凝血途径。急性冠脉综合征患者血浆Tf水平高于稳定性劳力型心绞痛患者。血浆TFP I可分为游离TFP I和脂蛋白相关TFP I，脂蛋白相关TFP I的抗凝活性明显低于游离TFP I。ACS患者血浆游离TFP I水平升高，TFP I与TF共存于冠状动脉的各种动脉粥样硬化病变中。总之，血浆Tf和TFPI水平的升高反映了急性冠脉综合征患者冠状动脉不稳定斑块中Tf和TFPI的高表达。血小板聚集性的评估使用了一种新型的激光散射聚集仪，它可以确定小、中、大聚集的总光强度。急性冠脉综合征患者较稳定性劳力型心绞痛患者的小血小板聚集率明显增加。急性冠脉综合征患者的中、大型血小板聚集性不增加，入院时小血小板聚集性增加预示患者住院期间预后不良。另一方面，不稳定型心绞痛和Tf水平升高的患者预后不良的风险增加。综上所述，血浆TF水平升高和小血小板聚集性增加与急性冠脉综合征患者冠状动脉事件的复发有关，对于血浆TF水平升高或小血小板聚集性增加的ASC患者应给予足够的抗凝或抗血小板治疗以改善其水平。

Hypercoagulability is associated with expression of tissue factor (TF) in patients with acute coronary syndromes (ACS). Tissue factor pathway inhibitor (TFPI) regulates the extrinsic coagulation pathway mediated by TF.Plasma TF levels were higher in patients with ACS than in those with stable exertional angina. TF expressed on macrophages in directional coronary atherectomy specimens obtained from patients with ACS.Plasma TFPI can be separated into free TFPI and lipoprotein associated TFPI.Anticoagulant activity of lipoprotein-associated TFPI is markedly lower than free TFPI.The plasma free TFPI levels were elevated in patients with ACS.TFPI is co-localized with TF in various atherosclerotic lesions of coronary artery. In conclusion, the increase of plasma TF and TFPI levels reflects the heightened expression of TF and TFPI at unstable coronary plaques in patients with ACS.Platelet aggregability was evaluated using a new aggregometer with Iaser-light scattering which can determine the total light intensities of small, medium, and large-sized aggregates. Production of small-sized platelet aggregates were increased in patients with ACS than those with stable exertional angina. Production of medium or large-sized platelet aggregates were not increased in patients with ACS.Furthermore, increased number of small-sized platelet aggregates on admission predicted poor prognosis during in-hospital stay in patients with ACS.On the other hand, patients with unstable angina and heightened TF levels were at increased risk for unfavorable outcomes. In conclusion, the elevated plasma TF levels and small-sized platelet aggregates are associated with reccurrence of coronary events in patients with ACS.Patients with ASC who have elevated plasma TF levels or increased small-sized platelet aggregates should receive enough anti-coagulation or anti-platelet therapy to improve the levels.