Clinical profile, common thrombophilia markers and risk factors in 85 young Indian patients with arterial thrombosis

CONTEXT AND OBJECTIVE: Arterial thrombosis may occur consequent to hereditary thrombophilia and increased lipoprotein(a) [Lp(a)] and fibrinogen. Our aim was to study the prevalence of common thrombophilia markers in 85 consecutive cases of arterial thrombosis. DESIGN AND SETTING: A retrospective study was conducted from 85 consecutive young patients treated as outpatients or admitted due to stroke or myocardial infarction at a tertiary care hospital. METHODS: Eighty-five Indian patients (age < 45 years) presenting ischemic stroke (n = 48) or myocardial infarction (n = 37) and 50 controls were studied for seven thrombophilia markers including antithrombin (AT), factor V, protein C, protein S, activated protein C resistance (APC-R), fibrinogen and Lp(a). Functional assays for protein C, protein S, factor V and APC-R were performed using clotting-based methods. Semi-quantitative estimation of fibrinogen was done using Clauss's method and Lp(a) using immunoturbidimetry. Statistical analysis was done using the Epi Info 6 software. RESULTS: Thirty-three samples (38.8%) tested positive for one or more thrombophilia markers. The three commonest abnormalities were elevated Lp(a) (20%), fibrinogen (17.6%) and low APC-R (14.2%). Low levels of protein C, protein S and AT were present in 4.7, 9.4 and 7% of the patients, respectively. Overall, the risk factor profile was: smoking (33%), positive family history (15.3%), hyperlipidemia (7%), hypertension, diabetes mellitus and obesity (2.3% each). CONCLUSIONS: An association was found between low levels of protein C, protein S and AT and arterial thrombosis, but only elevated fibrinogen levels, smoking, positive family history and hyperlipidemia showed statistical significance.

研究背景与目的：动脉血栓形成可由遗传性血栓形成倾向、脂蛋白(a)[Lp(a)]水平升高及纤维蛋白原异常引发。本研究旨在探讨85例连续性动脉血栓形成患者中常见血栓形成倾向标志物的检出率。
研究设计与实施场景：本研究为回顾性研究，纳入某三级医院收治的85例连续性年轻患者（年龄<45岁），均因缺血性脑卒中（48例）或心肌梗死（37例）接受门诊治疗或住院治疗，同时设置50例对照人群。
研究方法：本研究对85例印度裔年轻患者（年龄<45岁）及50例对照人群开展7项血栓形成倾向标志物检测，包括抗凝血酶（antithrombin, AT）、V因子、蛋白C、蛋白S、活化蛋白C抵抗（activated protein C resistance, APC-R）、纤维蛋白原及脂蛋白(a)[Lp(a)]。其中蛋白C、蛋白S、V因子及APC-R的功能检测采用凝血法；纤维蛋白原采用Clauss法进行半定量检测，脂蛋白(a)采用免疫比浊法检测。统计分析采用Epi Info 6软件完成。
研究结果：33份样本（38.8%）的一项或多项血栓形成倾向标志物检测结果呈阳性。最常见的三项异常分别为脂蛋白(a)水平升高（20%）、纤维蛋白原水平升高（17.6%）及活化蛋白C抵抗降低（14.2%）。蛋白C、蛋白S及抗凝血酶水平降低的患者占比分别为4.7%、9.4%及7%。整体危险因素谱包括：吸烟（33%）、阳性家族史（15.3%）、高脂血症（7%）、高血压、糖尿病及肥胖（各占2.3%）。
研究结论：本研究发现蛋白C、蛋白S及抗凝血酶水平降低与动脉血栓形成存在关联，但仅纤维蛋白原水平升高、吸烟、阳性家族史及高脂血症具有统计学显著性。