ADAMTS-13调控急性心肌梗死的机制研究

ADAMTS-13是一种金属蛋白酶,可特异性切割血管性血友病因子(VWF),从而防止白细胞过度募集,下调炎症和血栓的形成。ADAMTS-13与VWF现在被认为在越来越多的血管炎症和血栓形成的疾病中起重要作用,特别是在急性心肌梗死(AMI)中研究越来越深入。ADAMTS-13结构与功能和AMI发生机制密切相关。本篇综述主要阐述ADAMTS-13调控AMI的作用机制。

ADAMTS-13在血栓性疾病中作用的研究进展

血管性血友病因子裂解酶(ADAMTS-13)是血浆中一种重要的金属蛋白酶,目前对于它的结构、生物学特征及其功能方面的研究已经取得较大的进展,除外调控vWF的裂解,ADAMTS-13在动、静脉血栓中也发挥着重要的作用,而离子浓度和凝血酶信号转导通路都会影响ADAMTS-13的活性,但ADAMTS-13如何受控的机制还不是很清楚。本文将对其改变,相关机制以及影响该酶调控的因素进行综述。

血浆ADAMTS-13活性和NLR在急性肺血栓栓塞症中的诊断价值

【目的】探究急性肺血栓栓塞症(PTE)患者血浆血管性血友病因子(vWF)活性、血管性血友病因子裂解酶(ADAMTS-13)活性、中性粒细胞计数与淋巴细胞计数比率(NLR)健康对照组的表达差异,探究ADAMTS-13活性、NLR对于PTE患者的诊断意义。【方法】共纳入急性PTE患者64例及健康对照者30例,收集相关临床数据并采用酶联免疫吸附试验(ELISA)检测血浆ADAMTS-13活性、vWF活性,分析比较ADAMTS-13活性、vWF活性的组间差异及其与其他临床指标的相关性,绘制受试者工作特征曲线(ROC)评价ADAMTS-13活性及NLR对急性PTE患者的诊断价值。【结果】健康对照组与急性PTE组ADAMTS-13活性水平分别为83.8%(72.2%,98.8%)、63.3%(49.6%,74.8%),vWF活性水平分别为102.7%(89.7%,117.2%)、122.6%(96.8%,156.6%),组间差异均具有统计学意义(P<0.05),ADAMTS-13活性与vWF活性、D-二聚体水平呈负线性相关(P<0.05)。多因素Logistic回归结果示NLR的升高为患急性PTE的独立危险因素[OR=1.66,95%CI(1.10,2.47),P=0.014],ADAMTS-13活性的升高为患急性PTE的独立保护因素[OR=0.92,95%CI(0.88,0.96),P<0.001]。ADAMTS-13活性用于诊断急性PTE时,ROC曲线下面积(AUC)为0.861,95%CI(0.780,0.942),P<0.001,联合NLR用于诊断急性PTE时,AUC为0.902,95%CI(0.841,0.963),P<0.001。【结论】急性PTE患者血浆ADAMTS-13活性显著下降,vWF活性显著上升,AD⁃AMTS-13、vWF或为沟通血栓形成与炎症反应间的桥梁,血浆ADAMTS-13活性联合NLR可提高诊断急性PTE的准确性,为探寻急性PTE的致病机制提供新的思路,为探寻急性PTE治疗靶点提供实验依据。

冠心病患者血清ADAMTS-1、ADAMTS-13含量与斑块性质、炎症及脂肪因子的相关性

目的:探讨冠心病患者血清ADAMTS-1、ADAMTS-13含量与斑块性质、炎症及脂肪因子的相关性。方法:选择2014年9月~2017年6月在本院进行检查的冠心病患者106例作为冠心病组,健康志愿者100例作为正常对照组。对比两组研究对象血清中ADAMTS-1、ADAMTS-13含量以及斑块性质相关指标、炎症因子、脂肪因子含量的差异。采用Pearson检验评估冠心病患者血清中ADAMTS-1、ADAMTS-13的含量与斑块性质、炎症及脂肪因子的相关关系。结果:冠心病组患者血清中ADAMTS-1的含量高于正常对照组,ADAMTS-13的含量低于正常对照组;血清中斑块性质相关指标同型半胱氨酸(Hcy)、尿酸(UA)含量高于正常对照组;血清中炎症因子高迁移率族蛋白B1(HMGB1)、白介素(IL)-6、IL-8、IL-18的含量高于正常对照组;血清中脂肪因子脂联素(APN)、腹腔脂肪型丝氨酸蛋白酶抑制剂(Vaspin)含量低于正常对照组,内脂素(Visfatin)、视黄醇结合蛋白4(RBP4)含量高于正常对照组,差异均有统计学意义(P<0.05)。Pearson检验发现,冠心病患者血清中ADAMTS-1、ADAMTS-13的含量与斑块性质相关指标、炎症及脂肪因子的含量直接相关。结论:冠心病患者血清ADAMTS-1含量异常增高、ADAMTS-13含量异常降低,具体含量与冠心病病情直接相关。

Correlation of serum ADAMTS-1 and ADAMTS-13 contents with plaque nature, inflammatory factors and adipocytokines in patients with coronary heart disease

Objective: To investigate the correlation of serum ADAMTS-1 and ADAMTS-13 contents with plaque nature, inflammatory factors and adipocytokines in patients with coronary heart disease. Methods: A total of 106 patients with coronary heart disease undergoing examination in the hospital between September 2014 and June 2017 were enrolled in coronary heart disease group, and 100 healthy volunteers were enrolled in normal control group. Differences in serum ADAMTS-1, ADAMTS-13, plaque nature-related index, inflammatory factor and adipocytokine contents were compared between the two groups. Pearson test was used to assess the correlation of ADAMTS-1 and ADAMTS-13 contents with plaque nature, inflammatory factor and adipocytokines in patients with coronary heart disease. Results: Serum ADAMTS-1 content of coronary heart disease group was higher than that of normal control group whereas ADAMTS-13 content was lower than that of normal control group;serum plaque nature-related indexes Hcy and UA contents were higher than those of normal control group;serum inflammatory factors HMGB1, IL-6, IL-8 and IL-18 contents were higher than those of normal control group;serum adipocytokines APN and Vaspin contents were lower than those of normal control group whereas Visfatin and RBP4 contents were higher than those of normal control group. Pearson test showed that serum ADAMTS-1 and ADAMTS-13 contents of patients with coronary heart disease were directly correlated with the contents of plaque nature-related indexes, inflammatory factors and adipocytokines. Conclusion: Serum ADAMTS-1 content abnormally increases and ADAMTS-13 content abnormally decreases in patients with coronary heart disease, and the specific contents are directly correlated with the condition of coronary heart disease.

ADAMTS-13与血栓性血小板减少症

血栓性血小板减少症（thrombotic thrombocy-topenic purpura,TTP）的基本病理特征为微血管血栓与血小板减少。近年来,TTP的病因与发病机制已逐步阐明,治疗效果有了根本的改观。TTP基础与临床研究的突破性成就代表了当前血液学的重大进展之一。1

血栓性血小板减少性紫癜/溶血性尿毒症综合征的研究进展

1历史1924年Eli Moschwitz报道了一名16岁患者在突然起病后2周内死亡，症状有点状出血、皮肤苍白、发热、麻痹、血尿和昏迷。尸检时发现其微血管内有散在由血小板构成的玻璃样血栓，主要分布在小动脉和毛细血管。

获得性血栓性血小板减少性紫癜1例报道并文献复习

血栓性血小板减少性紫癜(thrombotic thrombo-cytopenic purpura,TTP)起病急,病情凶险,病死率极高,早期容易漏诊或误诊,本文对2020年10月12日南京中医药大学附属苏州市中医医院诊治的1例以免疫性血小板减少性紫癜(immune thrombo-cytopenic purpura,ITP)为基础病,合并血栓性血小板减少性紫癜的患者进行分析报道,并复习相关文献。