背景:小腿损伤和接受膝关节镜检查的患者发生静脉血栓栓塞的风险增加。机制未知,包括小腿损伤和膝关节镜检查对自然抗凝因子和纤维蛋白溶解的影响。
目的:研究小腿损伤和膝关节镜检查对血浆抗凝和纤溶因子水平的影响。
方法:我们应用了以下2种设计来研究这种效果:小腿创伤的横断面研究和膝关节镜检查的前后研究。分析POT-CAST和POT-KAST随机临床试验参与者的血浆样本(在小腿创伤后不久或关节镜检查前后收集)的凝块溶解时间和抗凝血酶水平,组织因子途径抑制剂,蛋白C,游离蛋白S,纤溶酶原,组织纤溶酶原激活剂,纤溶酶原激活物抑制剂1,抗纤溶酶,凝血酶激活的纤溶抑制剂,纤溶酶-抗纤溶酶,和D-二聚体。对于小腿受伤的影响,将289例患者的样本与293例关节镜检查患者的术前样本进行比较,使用线性回归和调整年龄作为对照,性别,身体质量指数,合并症,和昼夜变化。对于膝关节镜的效果,我们使用经昼夜变化校正的线性混合模型计算了277例患者的平均变化.在较小的亚群中测量除CLT和D-二聚体以外的参数。
结果:在小腿损伤患者中,大多数参数是稳定的,而D-二聚体增加。关节镜检查后,大多数参数降低(特别是凝块溶解时间,D-二聚体,纤溶酶原,和抗凝因子),而组织纤溶酶原激活物和凝血酶激活的纤溶抑制剂略有增加。
结论:与小腿损伤相反,膝关节镜检查与天然抗凝因子水平降低相关.小腿损伤和膝关节镜检查均不影响体内纤维蛋白溶解。
Patients with lower-leg injuries and those undergoing knee arthroscopy are at increased risk of developing venous thromboembolism. The mechanism is unknown, including the influence of lower-leg injury and knee arthroscopy on natural anticoagulant factors and fibrinolysis.
To study the effect of lower-leg injury and knee arthroscopy on plasma levels of anticoagulant and fibrinolytic factors.
We applied the following 2 designs to investigate this effect: a cross-sectional study for lower-leg trauma and a before-and-after study for knee arthroscopy. Plasma samples of POT-CAST- and POT-KAST-randomized clinical trial participants (collected shortly after lower-leg trauma or before or after arthroscopy) were analyzed for clot lysis time and levels of antithrombin, tissue factor pathway inhibitor, protein C, free protein S, plasminogen, tissue plasminogen activator, plasminogen activator inhibitor 1, antiplasmin, thrombin activatable fibrinolysis inhibitor, plasmin-antiplasmin, and D-dimer. For the effect of lower-leg injury, samples of 289 patients were compared with preoperative samples of 293 arthroscopy patients, acting as controls using linear regression and adjusting for age, sex, body mass index, comorbidities, and diurnal variation. For the effect of knee arthroscopy, mean changes were calculated for 277 patients using linear mixed models adjusted for diurnal variation. Parameters other than CLT and D-dimer were measured in smaller subsets.
In lower-leg injury patients, most parameters were stable, whereas D-dimer increased. After arthroscopy, most parameters decreased (especially clot lysis time, D-dimer, plasminogen, and anticoagulant factors), whereas tissue plasminogen activator and thrombin activatable fibrinolysis inhibitor slightly increased.
In contrast to lower-leg injury, knee arthroscopy was associated with decreased natural anticoagulant factor levels. Neither lower-leg injury nor knee arthroscopy affected in vivo fibrinolysis.