无诱因肺血栓栓塞症患者天然抗凝蛋白活性缺陷发生率的研究
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摘要
目的:探讨汉族无诱因肺血栓栓塞症(uPTE)患者和健康人群中蛋白C(PC)、蛋白S(PS)和抗凝血酶Ⅲ(ATⅢ)三种天然抗凝蛋白(NA)活性缺陷的发生率。方法:自2010年1月至2017年12月,连续分析我院呼吸与危重症医学科住院的汉族uPTE患者265例和汉族健康对照人群68例,检测PC,PS和ATⅢ三种NA的活性水平并计算活性缺陷的发生率。结果:265例汉族uPTE患者三种NA缺陷的发生率为34.3%(91/265),PC和PS联合缺陷31例(11.7%)、单纯PC缺陷28例(10.6%)和单纯PC缺陷22例(8.3%)居于发生率的前三位,性别间差异无统计学意义(P=0.78),总发生率显著高于健康对照组2例(2.9%,P<0.01)。结论:我国汉族uPTE患者中NA缺陷发生率高,性别间无差异,显著高于健康人群,对PTE的发生有重要影响。
Objective: To analysis the prevalence of deficiency on natural anticoagulant( NA) including protein C( PC),protein S( PS) and antithrombin Ⅲ( ATⅢ) in Han Chinese patients with unprovoked pulmonary thromboembolism( uPTE). Methods: Consecutive 265 Han Chinese uPTE patients( 140 male,125 female) in department of pulmonary and critical care medicine in Beijing Anzhen Hospital from January 2010 to December 2017 and 68 healthy controls were enrolled. Levels of PC,PS and ATⅢ and incidence of these deficiencies were analyzed. Results: Prevalence of NA deficiency including PC,PS and ATⅢ in Han Chinese uPTE patients is 34. 3%( 91/265). 31 patients( 11. 7%) suffered from combined PC and PS deficiency,28( 10. 6%) with PS and 22( 8. 3%) with PC deficiency respectively,which were most 3 common deficiency pattern. No difference of incidence with NA deficiencies was observed between genders( P = 0. 78). Compared to health controls( 2. 9%),the incidence with NA deficiencies was significantly higher in uPTE patients( P <0. 01). Conclusion: It indicated that the prevalence of NA deficiency was high in Han Chinese uPTE patients compared to health controls and no difference was observed between genders. NA deficiency may be correlated with the pathogenesis of PTE.
Objective: To analysis the prevalence of deficiency on natural anticoagulant( NA) including protein C( PC),protein S( PS) and antithrombin Ⅲ( ATⅢ) in Han Chinese patients with unprovoked pulmonary thromboembolism( uPTE). Methods: Consecutive 265 Han Chinese uPTE patients( 140 male,125 female) in department of pulmonary and critical care medicine in Beijing Anzhen Hospital from January 2010 to December 2017 and 68 healthy controls were enrolled. Levels of PC,PS and ATⅢ and incidence of these deficiencies were analyzed. Results: Prevalence of NA deficiency including PC,PS and ATⅢ in Han Chinese uPTE patients is 34. 3%( 91/265). 31 patients( 11. 7%) suffered from combined PC and PS deficiency,28( 10. 6%) with PS and 22( 8. 3%) with PC deficiency respectively,which were most 3 common deficiency pattern. No difference of incidence with NA deficiencies was observed between genders( P = 0. 78). Compared to health controls( 2. 9%),the incidence with NA deficiencies was significantly higher in uPTE patients( P <0. 01). Conclusion: It indicated that the prevalence of NA deficiency was high in Han Chinese uPTE patients compared to health controls and no difference was observed between genders. NA deficiency may be correlated with the pathogenesis of PTE.
引文
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[15]朱铁楠,赵永强,丁秋兰,等.汉族人群蛋白C、蛋白S和抗凝血酶活性水平及活性缺乏发生率的研究.中华血液病杂志,2012,33(2):127-130.
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[18]Suehisa E,Nomura T,Kawasaki T,et al.Frequency of natural coagulation inhibitor(antithrombin Ⅲ,protein C and protein S)deficiencies in Japanese patients with spontaneous deep vein thrombosis.Blood Coagul Fibrinolysis.2001,12(2):95-99.
[19]Shen MC,Lin JS,Tsay W.Protein C and protein S deficiencies are the most important risk factors associated with thrombosis in Chinese venous thrombophilic patients in Taiwan.Thromb Res.2000,99:447-452.
[20]Chen TY,Su WC,Tsao CJ.Incidence of thrombophilia detected in southern Taiwanese patients with venous thrombosis.Ann Hematol,2003,82(2):114-117.
[21]Liu HW,Kwong YL,Bourke C,et al.High incidence of thrombophilia detected in Chinese patients with venous thrombosis.Thromb Haemost.1994,71(4):416-419.
[22]白春梅,潘家绮,范连凯,等.静脉血栓患者抗凝蛋白缺陷研究.中华内科杂志.2000,39(11):746-748.
[23]邸平,梁臻龙,徐丽娟,等.静脉血栓栓塞症患者及脑梗塞患者易栓因素研究.血栓与止血学.2016,22(6):630-632.
[24]王增智,赵秀清,郭伟,等.肺血栓栓塞症患者易栓症的分析研究.心肺血管病杂志,2010,29(5):357-359.
[2]Couturaud F,Leroyer C,Julian JA,et al.Factors that predict risk of thrombosis in relatives of patients with unprovoked venous thromboembolism.Chest,2009,136:1537-1545.
[3]中华医学会血液学分会血栓与止血学组.易栓症诊断中国专家共识(2012年版).中华血液病杂志,2012,33(11):982.
[4]中华医学会呼吸病学分会肺栓塞与肺血管病组,中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会,全国肺栓塞与肺血管病防治协作组.肺血栓栓塞症诊治与预防指南.中华医学杂志.2018,98(14):1060-1087.
[5]Egeberg O.Inherited antithrombin deficiency causing thrombophilia.Thromb Diath Haemorrh.1965,13:516-530.
[6]Griffin JH,Evatt B,Zimmerman TS,et al.Deficiency of protein in congenital thrombotic disease.J Clin Invest.1981,68(5):1370-1373.
[7]Comp PC,Nixon RR,Cooper MR,et al.Familial protein S deficiency is associated with recurrent thrombosis.J Clin Invest.1984,74(6):2082-2088.
[8]Poort SR,Rosendaal FR,Reitsma PH,et al.A common genetic variation in the 39-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis.Blood,1996,88(10):3698-3703.
[9]Martinelli I,De Stefano V,Mannucci PM.Inherited risk factors for venous thromboembolism.Nat Rev Cardiol,2014,11(3):140-156.
[10]Ridker PM,Miletich JP,Hennekens CH,et al.Ethnic distribution of factor V Leiden in 4047 men and women.Implications for venous thromboembolism screening.JAMA,1997,277:1305-1307.
[11]Kim HJ,Seo JY,Lee KO,Bang SH,et al.Distinct frequencies and mutation spectrums of genetic thrombophilia in Korea in comparison with other Asian countries both in patients with thromboembolism and in the general population.Haematologica,2014,99:561-569.
[12]郑红,连建华,贺颖,等.中国人群凝血酶原FⅡG20210A和FV Leiden的分布.郑州大学学报(医学版).2006,41(1):102-104.
[13]杨忠伟,冯秀丽,肖白,等.新疆蒙古族冠心病人群中FV Leiden基因突变的研究—附41例报告.新医学.2009,40(7):445-447.
[14]胡雪梅,艾力曼·马合木提,夏玉宁,等.维吾尔族静脉血栓栓塞症与凝血酶原G20210A和凝血因子V Leiden突变的相关性研究.新疆医科大学学报.2015,38(1):38-43.
[15]朱铁楠,赵永强,丁秋兰,等.汉族人群蛋白C、蛋白S和抗凝血酶活性水平及活性缺乏发生率的研究.中华血液病杂志,2012,33(2):127-130.
[16]Lee M,No HJ,Jang SY,Kim N,et al.Hereditary thrombophilia in Korean patients with idiopathic pulmonary embolism.Yonsei Med J,2012,53(3):571-577.
[17]Kim S,Song I,Kim HK,et al.Thrombophilia in Korean patients with arterial or venous thromboembolism.Ann Surg Treat Res,2016,90(6):340-345.
[18]Suehisa E,Nomura T,Kawasaki T,et al.Frequency of natural coagulation inhibitor(antithrombin Ⅲ,protein C and protein S)deficiencies in Japanese patients with spontaneous deep vein thrombosis.Blood Coagul Fibrinolysis.2001,12(2):95-99.
[19]Shen MC,Lin JS,Tsay W.Protein C and protein S deficiencies are the most important risk factors associated with thrombosis in Chinese venous thrombophilic patients in Taiwan.Thromb Res.2000,99:447-452.
[20]Chen TY,Su WC,Tsao CJ.Incidence of thrombophilia detected in southern Taiwanese patients with venous thrombosis.Ann Hematol,2003,82(2):114-117.
[21]Liu HW,Kwong YL,Bourke C,et al.High incidence of thrombophilia detected in Chinese patients with venous thrombosis.Thromb Haemost.1994,71(4):416-419.
[22]白春梅,潘家绮,范连凯,等.静脉血栓患者抗凝蛋白缺陷研究.中华内科杂志.2000,39(11):746-748.
[23]邸平,梁臻龙,徐丽娟,等.静脉血栓栓塞症患者及脑梗塞患者易栓因素研究.血栓与止血学.2016,22(6):630-632.
[24]王增智,赵秀清,郭伟,等.肺血栓栓塞症患者易栓症的分析研究.心肺血管病杂志,2010,29(5):357-359.