摘要
深静脉血栓(DVT)是指血液在深静脉内不正常的凝结,导致管腔内的血液回流受阻。DVT不仅具有较高的致残率和致死率,血栓形成后综合征的治疗还会给患者带来较高的经济负担。由于缺乏合适的啮齿类动物模型,目前DVT的发病机制仍不清楚。长期以来,DVT被认为是血液凝固障碍,DVT的预防主要涉及凝血系统,包括针对凝血酶(达比加群)、活化FXa(利伐沙班)或依赖维生素K的凝血因子(华法林)。然而,正常止血和病理性血栓形成机制重叠性较大,针对凝血系统的抗凝剂治疗窗窄,易引起出血并发症。近年来,研究表明免疫细胞和细胞因子参与了DVT的启动,并在DVT的形成过程可能起着关键性的作用。这些研究认为DVT为免疫和炎症相关过程,而不仅仅只是凝血因子依赖性的血栓形成过程。其中,与DVT形成密切相关的免疫细胞主要包括肥大细胞、中性粒细胞、单核细胞、血小板等;细胞因子主要包括P-选择素、补体激活因子、细胞粘附分子、白介素等。此外,活性氧、髓样相关蛋白-14等也参与了DVT的形成。局部静脉血流停滞引起缺氧、血管内皮细胞激活、多种免疫细胞在内皮表面发生聚集,最终引起静脉内血栓形成。炎症细胞因子则涉及到上述各个过程中,它与免疫细胞在DVT的形成过程中都起着至关重要的作用。现分别综述各免疫细胞及细胞因子在DVT形成中的研究进展。
Deep vein thrombosis(DVT)is an abnormal formation of a blood clot within a deep vein,which causes blood flow back in the lumen to be blocked.DVT not only has high morbidity and mortality,but also has a high economic burden to patients.The pathogenesis is still unclear due to the absence of suitable DVT model.DVT has long been considered as a blood coagulation disorder.DVT prophylaxis focuses predominantly on the coagulation system,including thrombin(Dabigatran),active FXa(Rivaroxaban)or vitamin K-dependent clotting factors(Warfarin).Nevertheless,due to the mechanisms of normal hemostasis and pathological thrombosis are greatly overlapped,the therapeutic window of anticoagulants may be narrow because of increased risks for bleeding complications.Recently studies demonstrate that immune cells and cytokines are involved in DVT initiation,and may play a vital role in DVT.These studies consider DVT as an immunity-and inflammation-related process rather than merely coagulation-dependent thrombosis.Immune cells related to the formation of DVT include mast cells,neutrophils,monocytes,platelets,etc.The cytokines mainly include P-selectin,complement activator,cell adhesion molecule,interleukin,etc.Additionally,ROS and MRP-14 are all play an important role in DVT.Blood flow stagnation in the vein results in hypoxia,following with endothelial activation and recruitment of various immune cells,which leading to intravenous thrombosis.Inflammatory cytokines are involved in the processes,and they play a crucial role in DVT with immune cells.Now,we review the advance of research on various immune cells and cytokines in DVT,respectively.
作者
杨文娟
夏仲尼
王晓栋
应茵
YANG Wen-juan;XIA Zhong-ni;WANG Xiao-dong(Department of Pharmacy,TongDe Hospital of Zhejiang Province,Hangzhou,Zhejiang 310012,China)
出处
《中华全科医学》
2019年第11期1898-1901,共4页
Chinese Journal of General Practice
基金
浙江省自然科学基金项目(LQ14H280003)
浙江省医药卫生科技计划项目(2013KYB062)
