Relationship between coagulation cascade, cytokine, adhesion molecule and aortic aneurysm.
OBJECTIVE
Patients with aortic aneurysm (AA) were in the chronic inflammatory condition and are often combined with disseminated intervascular coagulation. Recent studies demonstrated that atherosclerosis was inflammatory disease. AA and severe atherosclerosis with ulcer formation contain macrophages and T lymphocytes and accelerate the production of interleukin (IL)-2, which activates lymphocytes and lead to further adhesion of leukocytes. This study was designed to clarify the coagulation condition, cytokine, adhesion molecule, and collagen turnover in patients with AA and finally their relationship with the aneurysmal size.


METHODS
Thrombin-antithrombin III complex (TAT), plasma D-dimer, serum type III procollagen peptide (PIIIP), serum soluble IL-2 receptor (sIL-2R), Free tissue factor pathway inhibitor (TFPI), and soluble intercellular adhesion molecule (ICAM-1) were measured preoperatively around the same period when computed tomography (CT) was taken in 17 patients with AA (mean age: 72.2 years). Age-matched (mean age:70 years) volunteers were served as control. Maximum aneurysmal size was measured by CT and aneurysmal volume was also calculated from CT.


RESULTS
AA patients showed significantly higher level in preoperative TAT and D-dimer compared to control (TAT: control 2.5+/-1.2 ng/ml, pre 7.2+/-4.5,ng/ml; P=0.0001; D-dimer: control 107+/-46 U/ml, pre 420+/-256 U/ml; P=0.0001). Cytokine also showed higher level preoperatively (sIL-2R: control 398+/-132 U/ml, pre 735+/-260 U/ml; P=0.0001). TFPI showed higher value preoperatively (control 22.9+/-4.9 ng/ml, pre 30.4+/-6.9 ng/ml; P=0.003). PIIIP (collagen turnover) showed no difference between the groups (P=0.0057) and neither did ICAM-1(P=0.0087). TAT (r=0.799, P=0.0001), D-dimer (r=0.56, P=0.0193), sIL-2R (r=0.709, P=0.0021), PIIIP (r=0.561, P=0.00239), and sICAM-1 (r=0.505, P=0.046) level showed positive correlation with aortic aneurysmal size and also TAT D-dimer, and sIL-2R levels were positively correlated with aneurysmal volume (r=0.714 P=0.0013, r=0.556 P=0.00204, r=0.693 P=0.0029, respectively).


CONCLUSIONS
AA patients were in the hypercoagulation and inflammatory condition. Aneurysmal size was well correlated with TAT, D-dimer, sIL-2R, PIIIP, and sICAM-1, suggesting that these markers could be good diagnostic and monitoring tool for the disease progression.
Nomura
Fumikazu
F
Department of Cardiovascular Surgery, National Hospital Kure Medical Center, 3-1 Aoyama, Kure, 737-0023, Hiroshima, Japan. fnomura@kure-nh.go.jp
Ihara
Akihiro
A
Yoshitatsu
Masao
M
Tamura
Kentaro
K
Katayama
Akira
A
Ihara
Katsuhiko
K
D000368:Aged; D000990:Antithrombin III / Q000032:analysis; D001014:Aortic Aneurysm / Q000097:blood* / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D015815:Cell Adhesion Molecules / Q000097:blood*; D016207:Cytokines / Q000097:blood* / Q000276:immunology; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000032:analysis; D008074:Lipoproteins / Q000032:analysis; D010446:Peptide Fragments / Q000032:analysis; D010447:Peptide Hydrolases / Q000032:analysis; D011347:Procollagen / Q000032:analysis; D015375:Receptors, Interleukin-2 / Q000097:blood; D019851:Thrombophilia / Q000097:blood* / Q000276:immunology
D015415:Biomarkers; D015815:Cell Adhesion Molecules; D016207:Cytokines; D005338:Fibrin Fibrinogen Degradation Products; D008074:Lipoproteins; D010446:Peptide Fragments; D011347:Procollagen; D015375:Receptors, Interleukin-2; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; C051928:lipoprotein-associated coagulation inhibitor; C041876:procollagen Type III-N-terminal peptide; D018799:Intercellular Adhesion Molecule-1; D000990:Antithrombin III; D010447:Peptide Hydrolases