Author/Editor		Cvelbar-Marinko, Tanja; Goršič-Tomažič, Karmen
Title		Pogostnost neodzivnosti na aktivirani protein C pri bolnikih z vensko trombozo
Translated title		Incidence of activated protein C resistance among patients with deep vein thrombosis
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 36, št. 3
Publication year		1997
Volume		str. 297-315
Language		slo
Abstract		A group of 100 consecutive patients treated for deep vein thrombosis in the Trnovo Hospital of Intemal Medicine from January 1992 to December 1994, was studied for the presence of a new type of thrombophilia - resistance to activated protein C. There were 40 women and 60 men, aged 16 to 60 years (x=39). Primary deep vein thrombosis was established in 38 patients (18 % women, 82 % men), and secondary deep vein thrombosis in 62 patients (53 % women, 74 % men). Thirty-two per cent of patients had a positive family history; 79 per cent were treated for the first episode of deep vein thrombosis and the remainder for recurrent episodes. Resistance to activated protein C was determinated using a ratio between activated partial thromboplastin time with purified activated protein C and activated partial thro boplastin time without activated protein C. The lower normal limit was determined by measuring the activated protein C ratio in 100 sex and age matched healthy subjects (mean minus 2+- SD). Subjects with an activated protein C ratio less than 2,0 were considered resistant to activated protein C. Twenty patients were excluded from the study because of anticoagulant treatment, and 9 because of the presence of lupus anticoagulants. Activated protein C resistance was established in 10 (14 %) of the remaining 71 patients (6 women and 4 men). In the control group, the prevalence of activated protein C resistance was 3 per cent (3 men) (p < 0,05). One patient showed antithrombin III deficiency, and 2 patients protein C deficiency but none of them had activated protein C resistance. There were no association between activated protein C resistance and primary or secondary deep vein thrombosis, positive family history and first or recurrent episodes of the disease. The results of the study indicate that activated protein C resistance is a frequent independent risk factor for deep vein thrombosis.
Summary		Pri 100 zaporednih bolnikih, ki so se zaradi venske tromboze zdravili na Interni kliniki Trnovo v obdobju med januarjem 1992 in decembrom 1994, smo iskali novo obliko trombofilije - neodzivnost na aktivirani protein C. Med njimi je bilo 40 žensk in 60 moških, starih od 16 do 60 let (x=39). Zaradi primarne venske tromboze se je zdravilo 38 bolnikov (18 % žensk, 82 % moških). Sekundarno vensko trombozo je imelo 62 bolnikov, med njimi je bilo 53 % žensk in 47 % moških. Pri 32 % bolnikov se je pojavIjala venska tromboza v družini, 79 % bolnikov se je zdravilo zaradi prve, ostali pa zaradi ponovne venske tromboze. Za določanje neodzivnosti na aktivirani protein C smo izračunavali razmerje med aktiviranim parcialnim tromboplastinskim časom ob dodatku aktiviranega proteina C in brez njega. Spodnjo mejo normalne vrednosti smo določili z meritvijo razmerja aktiviranega proteina C pri 100 zdravih osebah, ki so po spolu in starosti ustrezale bolnikom z vensko trombozo (x+- SD). Osebe, ki so imele razmerje aktiviranega proteina C pod 2,0, smo označili kot neodzivne na aktivirani protein C. Pri določanju neodzivnosti na aktivirani protein C smo zaradi jemanja kumarinov izključili 20 bolnikov, zaradi prisotnosti lupusnih antikoagulantov pa 9 bolnikov. Med 71 preostalimi bolniki smo odkrili neodzivnost na aktivirani protein C pri 10 (14%) bolnikih (6 žensk, 4 moški) za razliko od 3 (3 %) moških med kontrolnimi osebami (p < 0,05). Odkrili smo tudi 1 bolnika s pomanjkanjem antitrombina III in 2 bolnika s pomanjkanjem proteina C. Nihče od njih ni imel sočasne neodzivnosti na aktivirani protein C. Nismo odkrili povezave med neodzivnostjo na aktivirani protein C in primarno oz. sekundarno trombozo, družinskim pojavljanjem venske tromboze ter prvo oz. ponovno vensko trombozo. Rezultati naše raziskave kažejo, da je neodzivnost na aktivirani protein C pogost, samostojen dejavnik tveganja za nastanek venske tromboze.
Descriptors		THROMBOPHLEBITIS PROTEIN C PARTIAL THROMBOPLASTIN TIME