肺动脉血栓栓塞症与凝血纤溶系统失衡

在生理状态下,凝血与纤溶处于动态平衡状态;当这种平衡失衡时,便可招致出血不止或形成栓塞。体内某些抗凝途径的蛋白缺陷会使机体处于高凝状态而导致静脉血栓栓塞性疾病(VTE),已经报道有多种栓塞因素与VTE的发生有关;人们通常认为,慢性栓塞性肺动脉高压(CTE-PH)是静脉系统栓子反复脱落至肺动脉所致,很自然的会想到CTE-PH的发病可能与以上多种栓塞因素有关,然而,目前研究更倾向于CTEPH和VTE并没有直接的关系或者说是两个独立的疾病。

Pulmonary Thromboembolism and the Disturbances of Coagulation and Fibrinolysis

In physiology, the activities of the coagulation and fibrinolytic cascades are balanced. Disturbances of the balance between coagulation and fibrinolysis may result in a bleeding disorder or in a thrombotic tendency. Defects of different proteins involed in the antithrombotic pathways can result in a hypercoagulable state that may lead to a recurrent VTE. In the fibrinolytic pathways, many thrombophilic factors have been reported in patients with VTE. It is commonly accepted that CTE-PH is the result of single or recurrent pulmonary emboli arising from sites of venous thrombosis. So it increases our understanding of the role of these thrombophilic factors in CTE-PH. However, recent reports tend to sustain that CTE-PH and acute VTE might be separate and unrelated conditions.