慢性心力衰竭患者凝血功能及C反应蛋白的改变  

Coagulation Function and C-reactive Protein Change in Patients With Chronic Heart Failure

作　　者：王华[1] 杨杰孚[1] 张传宝[2] 包承鑫[3] 胡云建[4] 褚德发[5] 钟优[1] 李宏义[1] 张瑞生[1] 刘德平[1] 曾学寨[1] 

机构地区：[1]卫生部北京医院心内科,北京市100730 [2]卫生部临检中心 [3]中国医学科学院血液学研究所 [4]卫生部北京医院检验科,北京市100730 [5]卫生部北京医院统计室,北京市100730

出　　处：《中国循环杂志》2006年第3期178-181,共4页Chinese Circulation Journal

摘　　要：目的:研究慢性心力衰竭(心衰)患者中血浆组织因子(tissue factor,TF)活性、组织因子途径抑制物(tissue factor pathway inhibitor,TFPI)活性、血浆纤维蛋白原(Fibrinogen,Fg)等高凝状态指标,以及高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP),探讨慢性心衰患者中凝血系统激活状态以及炎症反应。方法:采用发色底物法分别测定慢性心衰患者(心衰患者根据是否有心房颤动分为两组:心衰1组为无心房颤动者,心衰2组为合并有心房颤动者)、心功能正常的心脏病患者(心脏病心功能正常组)和正常人(正常对照组)血浆TF活性和TFPI活性。用酶联免疫吸附法测定血浆D-二聚体、用全自动血凝分析仪测定血浆Fg、用免疫浊度法测定hs-CRP。结果:慢性心衰患者各组TF活性、TFPI活性、D-二聚体、Fg水平显著高于心脏病心功能正常组及正常对照组(P< 0．05-0．01)。慢性心衰患者各组中hs-CRP也显著高于心脏病心功能正常组及正常对照组(P<0．01)。心衰1组和心衰2组之间TF活性、TFPI活性、D-二聚体、Fg、hs-CRP的差异无显著性(P>0．05)。相关性分析显示心衰患者中TF活性与LVEF负相关(r=-0．38,P<0．05),Fg水平与hs-CRP正相关(r=0．37,P<0．05)。结论:慢性心衰患者中存在凝血系统的激活,TF促凝活性明显增加,存在明显的高凝状态,并且左心室收缩功能越低的患者中TF促凝活性越高。慢性心衰患者中hs-CRP显著升高提示心衰中存在炎症反应,并且与高凝状态有一定的关联。Objective：To investigate homeostatic function,especially for the role of tissue factor（TF） and tissue factor pathway inhibitor （TFPI） ,and high-sensitivity C-reactive protein（hs-CRP） as inflammatory biomarkers and their clinical significance in patients with heart failure. Methods：Thirty-eight patients with chronic heart failure were assigned to group 1 （without atrial fibrillationn, n = 20） or group 2 （with atrial fibrillationn, n = 18）. There were two age and sex matched control groups：one was in sinus rhythm with cardiovascular disease and normal heart function （n = 20）, the other induoling healthy subjects （n = 20）. The plasma TF activity and TFPI activity were analyzed with chromogenic assay. The plasma fibrin D-dimer was measured using enzyme linked immunoassay. Fibrinogen（Fg） and hs-CRP were measured. Results：Compared with the healthy control group and the normal heart function group,patients with heart failure had higher levels of TF activity,TFPI activity, D-dimer, Fg, and hs-CRP（ P 〈 0.05 ）. There were no significant differences in the levels of TF activity and TFPI activity, D-dimer, Fg and hs-CRP between group 1 and group 2 （ P 〉 0. 05 ）. In the heart failure patients,level of TF activity was negatively related to that of LVEF（P 〈 0. 05）, and the level of Fg was positively related to that of hs-CRP（ P 〈 0. 05）. Conclusion ： Patients with heart failure showed evidence of hypercoagnlability. Increased plasma hs-CRP suggests that there is an inflammatory lesion,which may correlated with for hypercoagulability.

关 键 词：心力衰竭 组织因子 组织因子途径抑制物 C反应蛋白质 

分 类 号：R541.6[医药卫生—心血管疾病]