肝硬化患者纤溶活性升高机制的研究  

To investigate the mechanism leading to hyperfibrinolysis in patients with liver cirrhosis associated with viral hepatitis

作　　者：丛玉隆[1] 魏玉香[1] 殷宗健[1] 张立文[1] 邓新立[1] 

机构地区：[1]解放军总医院临床检验中心,北京100853

出　　处：《中华检验医学杂志》2005年第5期504-507,共4页Chinese Journal of Laboratory Medicine

基　　金：北京市科委重大科技项目基金资助(H020920020290)

摘　　要：目的探讨肝硬化患者纤溶活性增高的机制.方法根据Child-Pugh分级把明确诊断为肝硬化的43例患者(男35例,女8例;年龄25～71岁,平均年龄51岁)分为3组,A组(A级)13例,B组(B级)15例,C组(C级)15例.另外B级和C级的患者根据腹水的有无,分别分成2组.对每例样本检测组织纤溶酶原激活物(t-PA)抗原、组织纤溶酶原激活物抑制剂(PAI)、纤维蛋白(原)降解产物(FDP)和D-二聚体(D-D).结果在有腹水的16例(B级和C级)肝硬化患者中,所有患者血浆D-D水平均大于1.0 mg/L, FDP水平均大于5 mg/L,平均D-D含量为3.97mg/L.14例(B级和C级)没有腹水的肝硬化患者中只有5例血浆D-D水平大于0.5 mg/L、 FDP水平大于5 mg/L,平均D-D含量为0.77 mg/L.另外,在同级病例中,有腹水患者的D-D水平远远大于没有腹水患者的D-D水平,差异有统计学意义(P<0.05).有腹水患者的t-PA水平略高于没有腹水的患者,但差异无统计学意义(P>0.05),有腹水患者的PAI水平与无腹水患者的水平近似,差异无统计学意义(P>0.05).23例具有正常纤溶活性(FDP<5 μg/ml;D-D<0.5 μg/ml)的病例,其中A级13例,B级6例,C级4例,t-PA抗原随病情严重程度而显著性升高,差异有统计学意义(P<0.05),而PAI活性在3组结果近似(P>0.05).另外,通过比较高纤溶活性和正常纤溶活性(B级和C级)t-Pa/ PAI变化.我们注意到在纤溶活性高的患者t-PA近似于正常纤溶患者,差异无统计学意义(P>0.05).结论腹水可能是肝硬化患者纤溶活性增高的重要因素;肝硬化本身在没有腹水的情况下,其纤溶活性略微升高;t-PA/PAI的失平衡随着病情的严重程度而升高;t-PA/PAI失平衡不是肝硬化患者纤溶活性升高的主要因素.Objective To investigate the mechanism leading to hyperfibrinolysis in patients with cirrhosis. Methods Forty-three patients (35 men, 8women; aged:25-71yr) with cirrhosis were divided into three subgroups (A, B and C) on the basis of Child-Pugh classification; Additionally, on the basis of ascites state (with or without ascites), B and C class patients (15 cases B class, 15 cases C class) were divided into two subgroups respectively. Tissue plasminogen activator antigen (t-PA), plasminogen activator inhibitor activity (PAI), fibrin/fibrinogen degradation products (FDP) and fragment D-dimer were measured for each patients. Results In all 16 patients with ascites, plasma D-dimer was elevated to the levels greater than 1.0 μg/ml and the mean D-dimer concentration was 3.97 mg/L, while in 5 of 14 patients without ascites, plasma D-dimer was elevated to the levels greater than 0.5 μg/ml and the mean concentration was 0.77 mg/L .Furthermore, in the same class patients (B or C class), the levels of plasma D-dimer of patients with ascites was greatly higher than without ascites and there was significant difference ( P <0.05). The levels of plasma t-PA antigen of patients with ascites were slightly higher than those without ascites, but the difference was no significant ( P >0.05). In patients without systemic signs of hyperfibrinolysis , we noted progressive increase of t-PA antigen from A to C class( P <0.05), whereas PAI activity did not display significant changes ( P >0.05). Additionally, we noted that the levels of t-PA and PAI of patients with hyperfibrionlysis were higher than those with normal fibrinolysis, but the difference was no significant ( P >0.05).Conclusions Our results suggest that ascites contributes to the exaggerated fibrinolysis in cirrhosis, whereas cirrhosis self, in the absence of ascites, leads to a slightly fibrinolynic state. The t-PA/PAI imbalance was not a main cause of hyperfibrinolysis in patients with cirrhosis.

关 键 词：肝硬化患者 纤溶活性 升高 CHILD-PUGH分级 组织纤溶酶原激活物抑制剂 纤维蛋白(原)降解产物 t-PA/PAI t-Pa/PAI 病情严重程度 活性增高 D-D D-二聚体 统计学 PAI活性 平均年龄 样本检测 患者血浆 5μg 腹水 51岁 FDP 

分 类 号：R575.2[医药卫生—消化系统] R544.1[医药卫生—内科学]