目的:探讨急性心肌梗死(AMI)患者循环微粒的特点及其促凝血的可能机制。
方法:进行前瞻性病例对照研究。纳入2023年6月至11月在哈尔滨市第一医院心内科二科收治的冠心病患者,根据患者是否发生AMI进行分组。入学那天,计算弥散性血管内凝血(DIC)评分.同时,采集空腹静脉血,以及D-二聚体的水平,检测纤维蛋白降解产物(FDP)和主要凝血因子的活性。通过微粒捕集法确定循环微粒的水平。通过组织因子(TF)依赖性FXa产生测定法检测携带组织因子(TFMP)的微粒水平。采用Spearman相关法分析各指标间的相关性。
结果:共纳入52例冠心病患者,其中AMI组26例,非AMI组26例。性别差异无统计学意义,年龄,体重指数(BMI),潜在的疾病,吸烟史,两组患者入院前治疗,这表明两组的基线数据是平衡和可比的。与非AMI组相比,DIC评分和D-二聚体,AMI组的FDP水平显着增加[DIC评分:3(3,4)vs.3(2,3),D-二聚体(mg/L):8.80(6.84,15.66)vs.2.13(1.64,3.86),FDP(mg/L):30.13(19.30,52.54)vs.20.00(13.51,28.37),所有P<0.01],提示AMI患者凝血激活程度更为严重。AMI组的凝血途径中主要凝血因子的消耗比非AMI组重[FII:59.45%(49.65%,71.25%)与63.65%(49.98%,73.22%),FV:96.95%(73.50%,112.78%)与105.05%(73.48%,131.48%),FVII:42.30%(36.98%,51.98%)与53.40%(46.58%,69.88%),FX:60.90%(48.22%,80.82%)与73.50%(56.80%,85.98%),FXI:82.45%(62.90%,99.10%)与92.40%(73.90%,114.25%),FXII:29.90%(12.42%,42.38%)与34.65%(16.32%,48.20%),均P<0.05]。AMI组循环TF+MP水平明显高于非AMI组[nmol/L:0.13(0.06,0.20)vs.0.08(0.04,0.15),P<0.05]。AMI组和非AMI组之间的循环微粒水平没有显着差异[nmol/L:1.24(0.71,3.77)。1.35(0.73,2.14),P>0.05]。相关性分析显示,冠心病患者循环TF+MP水平与凝血指标DIC评分呈显著正相关(r=0.307,P=0.027)。D-二聚体(r=0.696,P<0.001)和FDP(r=0.582,P<0.001),与外源性途径因子FVII(r=-0.521,P<0.001)和共同途径因子FX(r=-0.332,P=0.016)呈强负相关。
结论:AMI患者循环TF+MP水平明显高于非AMI患者。TF+MP可能在激活外源性凝血途径中起重要作用,加剧凝血因子消耗,并在AMI发生期间促进血凝块形成。
OBJECTIVE: To investigate the characteristic of circulating microparticle in patients with acute myocardial infarction (AMI) and its possible mechanism of promoting coagulation.
METHODS: A prospective case-control study was conducted. The patients with coronary heart disease admitted to the second department of cardiology in Harbin First Hospital from June to November 2023 were enrolled, and they were grouped according to whether the patients occurred AMI or not. On the day of admission, disseminated intravascular coagulation (DIC) score was calculated. At the same time, fasting venous blood was collected, and the levels of D-dimer, fibrin degradation product (FDP) and the activities of major coagulation factors were detected. The level of circulating microparticle was determined by microparticle trapping method. The microparticle carrying tissue factor (TF+MP) level was detected by tissue factor (TF) dependent F Xa production assay. Spearman correlation method was used to analyze the correlation among the indicators.
RESULTS: A total of 52 patients with coronary heart disease were enrolled, including 26 patients in AMI group and 26 patients in non-AMI group. There was no significant difference in gender, age, body mass index (BMI), underlying diseases, smoking history, and pre-admission treatment of patients between the two groups, indicating that the baseline data of the two groups were balanced and comparable. Compared with the non-AMI group, the DIC score and D-dimer, FDP levels in the AMI group were significantly increased [DIC score: 3 (3, 4) vs. 3 (2, 3), D-dimer (mg/L): 8.80 (6.84, 15.66) vs. 2.13 (1.64, 3.86), FDP (mg/L): 30.13 (19.30, 52.54) vs. 20.00 (13.51, 28.37), all P < 0.01], indicating that the degree of coagulation activation in AMI patients was more severe. The consumption of major coagulation factors in the coagulation pathway in the AMI group was heavier than that in the non-AMI group [F II: 59.45% (49.65%, 71.25%) vs. 63.65% (49.98%, 73.22%), F V: 96.95% (73.50%, 112.78%) vs. 105.05% (73.48%, 131.48%), F VII: 42.30% (36.98%, 51.98%) vs. 53.40% (46.58%, 69.88%), F X: 60.90% (48.22%, 80.82%) vs. 73.50% (56.80%, 85.98%), F XI: 82.45% (62.90%, 99.10%) vs. 92.40% (73.90%, 114.25%), F XII: 29.90% (12.42%, 42.38%) vs. 34.65% (16.32%, 48.20%), all P < 0.05]. The circulating TF+MP level in the AMI group was significantly higher than that in the non-AMI group [nmol/L: 0.13 (0.06, 0.20) vs. 0.08 (0.04, 0.15), P < 0.05]. There was no significant difference in the level of circulating microparticle between AMI group and non-AMI group [nmol/L: 1.24 (0.71, 3.77) vs. 1.35 (0.73, 2.14), P > 0.05]. Correlation analysis showed that circulating TF+MP level in the patients with coronary heart disease was significantly positively correlated with coagulation indicator DIC score (r = 0.307, P = 0.027), D-dimer (r = 0.696, P < 0.001) and FDP (r = 0.582, P < 0.001), and there was a strong negative correlation with exogenous pathway factor F VII (r = -0.521, P < 0.001) and common pathway factor F X (r = -0.332, P = 0.016).
CONCLUSIONS: The circulating TF+MP level in AMI patients was significantly higher than that in the non-AMI patients. TF+MP may play an important role in activating the extrinsic coagulation pathway, exacerbating coagulation factor consumption, and promoting clot formation during AMI occurrence.