哮喘联盟

   摘要
   背景：流行病学研究表明哮喘患者，特别是存在重症者，肺栓塞的风险增加。但是这些患者在病情稳定时是否存在血栓前状态并不清楚。
   目的：我们旨在比较病情稳定时健康受试者和轻度、重度、泼尼松龙依赖的哮喘患者的凝血和纤溶参数，并探讨止血标志物是否与气道炎症相关。
   方法：我们检测了126例（33例为健康对照受试者，31例为轻度哮喘患者，32例为重度哮喘患者，30例为泼尼松龙依赖的哮喘患者）成人血浆中的炎症参数（外周血嗜酸性粒细胞和中性粒细胞）、止血标志物（内源性凝血酶生成潜力[ETP]、凝血酶-抗凝血酶复合物、纤溶酶-α2-抗纤溶酶复合物、纤溶酶原激活物抑制因子-1[PAI-1]、D-二聚体和血管假性血友病因子[vWF]）。采用单向方差分析和事后Bonferroni检测进行组间比较，采用线性回归进行相关性分析。
   结果：我们发现与健康对照受试者相比，哮喘患者的ETP(121% vs 99%, 总体P <0.01)、纤溶酶-α2-抗纤溶酶复合物(520 vs 409 μg/L, 总体P = 0.04)、PAI-1(10 vs 7 ng/mL, 总体P = 0.02)和vWF(142% vs 87%, 总体P < 0.01)的水平增加。随着哮喘严重程度的增加，ETP、PAI-1和vWF的水平增加。此外，我们发现ETP和中性粒细胞的vWF相关，但与嗜酸性粒细胞计数无关。
   结论：哮喘患者存在血栓前状态，且随哮喘程度加重而增加。这可能解释了为什么哮喘患者，特别是严重者，静脉血栓栓塞的风险增加。
 

（杨冬 审校）
JAllergyClinImmunol. 2015Dec20.pii:S0091-6749(15)01672-3.doi:10.1016/j.jaci.2015.10.038. [Epub ahead of print]

 

Prothrombotic state in patients with severe and prednisolone-dependent asthma.
 

Sneeboer MM1, Majoor CJ2, de Kievit A2, Meijers JC3, van der Poll T4, Kamphuisen PW5, Bel EH2.
 

Abstract
BACKGROUND:Epidemiologic studies have shown that asthmatic patients, in particular those with severe disease, have increased risk of pulmonary embolism. It is unknown whether these patients have a prothrombotic state under stable conditions.
OBJECTIVE:We sought to compare coagulation and fibrinolysis parameters between healthy subjects and patients with mild, severe, and prednisolone-dependent asthma under stable conditions and to investigate whether hemostatic markers correlate with airway inflammation.
METHODS:In 126 adults (33 healthy control subjects, 31 patients with mild asthma, 32 patients with severe asthma, and 30 patients with prednisolone-dependent asthma) parameters of inflammation (peripheral blood eosinophils and neutrophils) and markers of hemostasis (endogenous thrombin potential [ETP], thrombin-antithrombin complex, plasmin-α2-antiplasmin complex, plasminogen activator inhibitor type 1 [PAI-1], D-dimer, and von Willebrand factor [vWF]) were measured in plasma. One-way ANOVA with the post hoc Bonferroni test was used for group comparison, and linear regression analysis was used for correlations.
RESULTS:We observed increased ETP (121% vs 99%, overall P < .01), plasmin-α2-antiplasmin complex (520 vs 409 μg/L, overall P = .04), PAI-1 (10 vs 7 ng/mL, overall P = .02), and vWF (142% vs 87%, overall P < .01) levels in asthmatic patients compared with healthy control subjects. ETP, PAI-1, and vWF levels increased with increasing asthma severity. In addition, we found a correlation between ETP and vWF with neutrophil but not eosinophil counts.
CONCLUSION:Asthmatic patients have a prothrombotic state that increases with asthma severity. This might explain why patients with asthma, in particular those with severe disease, have an increased risk of venous thromboembolism.
 

JAllergyClinImmunol. 2015Dec20.pii:S0091-6749(15)01672-3.doi:10.1016/j.jaci.2015.10.038. [Epub ahead of print]