DHF/DSS 患者凝血和纤溶系统变化的临床意义  

The dysregulation of coagulantion and fibrinolysis system in DHF/DSS

作　　者：唐小龙[1] 蔡淑玉[2] 方习武[3] 卢一平[4] 

机构地区：[1]广州暨南大学医学院免疫学教研室,安徽理工大学510632 [2]安徽理工大学 [3]中山大学第三附属医院 [4]广州市传染病医院

出　　处：《热带病与寄生虫学》2004年第4期198-201,共4页Journal of Tropical Diseases and Parasitology

摘　　要：目的检测 DHF/DSS 患者急性期凝血和纤溶系统的变化,探索患者血浆渗漏和出血的发病机制。方法收集正常健康者、DF 和 DHF/DSS 急性期患者的血浆各30份,应用 ELISA 法检测 t-PA、PAI-1、PC、TM、TF、TFPI 和 D-二聚体,发色底物法测 AT 等分子。结果血管内皮细胞的特异性表达产物 vWF 和TM 升高;TF升高,TFPI 没有变化;t-PA 显著增加,PAI-1下降,t-PA/PAI-1比值显著升高,PC、AT 和D-二聚体变化无统计学意义。结论 DHF/DSS 患者急性期血管内皮细胞活化或损伤的同时,凝血和纤溶系统均已活化;内皮细胞通过表达 TM、t-PA 和 PAI-1等相关分子在引起凝血和纤溶系统失调,造成血浆渗漏和出血等方面起重要作用。TM、t-PA 和 PAI-1等变化在 DHF/DSS 的发病机制中起重要作用,对 DHF/DSS 急性期有诊断价值,可作为辅助诊断指标。Objective The study was designed to investigated the changes of coagulant and fibrinolytic molecules during the acute stage of dengue hemorrhagic fever and dengue shock syndrome(DHF/DSS) to comprehend the patho- genesis of the capillary leakage and hemorrhage.Methods 90 citrated plasma specimens were collected,30 from healthy persons,30 from patients with DF and 30 from patients with DHF/DSS.Specimens then were analyzed,using enzyme-linked immunoadsorbent assay(ELISA) to determine and analyze the concentration values of vWF,TM,TF, TFPI,PC,t-PA,PAI-1 and D-Dimer,using chromogenic assay the activatity of AT.Results vWF,and TM, which were exclusively expressed and excreted by VECs,were found higher in the specimens from patients with DHF/ DSS than those from patients with DF and healthy persons.TF elevated,while TFPI remained normal,t-PA rised significantly,while PAI-1 declined and t-PA/PAI-1 rose notably.At the same time,The charge of PC,AT and D-Dimer were not statistically significant.Conclusions During the acute stage of DHF/DSS,at the same time VECs were actived and damaged,VECs plays a crucial role in the dysregulation of blood coagulation and fibrinolysis through the expression of these proteins such as TM,t-PA,and PAI-1,and it is important to induce capillary leakage and hemorrhage.The elevated level of TM and t-PA with the declined level of PAI-1 are important for DV to induce vasculopthy and coagulopathy,which is involved in the pathogenesis of hemorrhage,moreover they have high diagnosis value and can be used as early indicators of DHF/DSS.

关 键 词：DHF/DSS 纤溶系统 凝血 临床意义 ELISA法检测 血管内皮细胞活化 PAI-1 D-二聚体 辅助诊断指标 发病机制 TFPI 急性期患者 发色底物法 患者血浆 表达产物 相关分子 诊断价值 TM 健康者 升高 vWF 特异性 统计学 过表达 

分 类 号：R373.33[医药卫生—病原生物学] R743.33[医药卫生—基础医学]