静脉血栓的抗磷脂蛋白抗体与抗凝血、纤维蛋白溶解关系  

Relationship of Antiphospholipoprotein Antibodies of Venous Thrombi with Anticoagulation and Fibrinolysis

作　　者：陈朝晖[1] 郑艳珍[1] 唐剑[1] 李宁[1] 

机构地区：[1]中南大学湘雅医院医学实验研究中心

出　　处：《中国实验血液学杂志》2004年第6期733-736,共4页Journal of Experimental Hematology

摘　　要：为了探讨静脉血栓的病因病理及其与抗凝血、纤维蛋白溶解的关系 ,对 4 7例静脉血栓 (VT)患者用酶联免疫法检测抗心肌磷脂抗体 (ACA) ,用凝血法测定狼疮抗凝物 (LA)和抗活化蛋白C抗性 (APCR) ,用多聚酶链反应内切酶法鉴定因子VLeiden ,用发色底物法测定抗凝血酶Ⅲ (ATⅢ )、蛋白C(PC)、纤溶酶原 (Plg)、组织纤溶酶原激活物 (tPA)、组织纤溶酶原激活物抑制物 (tPAI)等抗凝血、纤维蛋白溶解活性。结果表明 :VT患者中 3 4 %有ACA和 (或 )LA阳性 ,其中以ACAIgG和LA为主 ;9.5 %的Plg缺乏 ,8.3 %的tPAI升高 (明显高于对照 ,P <0 0 0 5 ) ;ATⅢ、PC、tPA缺乏者依次为 4 .5 %、4 .5 %、2 .8% (与对照无差异性 ,P >0 .0 5 ) ;ATⅢ、PC、Plg联合缺乏者 1例 ;APCR未发现相应的factorVLeiden ;抗磷脂蛋白抗体 (APA)阳性和阴性组之间的各抗凝血和纤维蛋白溶解活性没有明显差异性 ;4例APCR阳性 ,3例ACA和 (或 )LA阳性 ,这 3例血浆和正常血浆混合后 2例APCR并没有完全得到纠正。结论 :抗磷脂蛋白抗体和纤维蛋白溶解异常是VT较多见的相关病理因素 ;LA和 (或 )ACA干扰蛋白C抗凝血途径 ,使之形成获得性APCR ,而此APCR可能是体内导致易栓的病因之一。To study the etiological factors and pathogenisis of venous thrombi and their relations with anticoagulation and fibrinolysis, In 47 patients with venous thrombi anticardiolipin antibody (ACA) was detected by ELISA. lupus anticoagulant (LA) and anti activative protein C resistance (APCR) were examined by coagulation test; factor V Leiden was determined by PCR; activity of anticoagulation and fibrinolysis of antithrombin (AT), protein C (PC), plasminogen (Plg) were detected by chromophore substrate methods. The results showed that ACA and/or LA were positive in 34% of patients with VT, most of which consisted of ACA IgG and LA; Plg was negative in 9.5% of patients; tPAI elevated in 8.3% of patients (much more than control group, P<0.005); ATⅢ,PC,tPA were negative in 4.5%,4.5%,2.8% of patients, respectively (no significant difference with control groups, P>0.05); ATⅢ,PC and Plg were negative constantly in one patient; factor V Leiden was not detected by PCR. There were no significant differences in anticoagulation and fibrinolysis between antiphospholipoprotein antibody (APA) negative subjects and APA positive subjects, 4 patients of which were positive in APCR, 3 patients were positive in ACA and/or LA, two out of three patients didn′t achieved APCR reversion after mixing their blood plasma with normal blood plasma. It is concluded that antiphospholipoprotein antibody and abnormal fibrinolysis were the common pathological factors in venous thrombi. LA and/or ACA disturbs the anticoagulation aspect to develop into acquired APCR which may be a possible cause leading to thrombophilia.

关 键 词：静脉血栓 抗磷脂蛋白抗体 抗活化性蛋白C抗性 纤维蛋白溶解 抗凝血 

分 类 号：R543.2[医药卫生—心血管疾病] R364.15[医药卫生—内科学]