急性肺损伤/急性呼吸窘迫综合征患者凝血纤溶系统的变化  

The changes of coagulation and fibrinolysis system in acute lung injury/acute respiratory distress syndrome

作　　者：叶伶[1] 金美玲[1] 徐晓波[1] 高磊[1] 白春学[1] 朱蕾[1] 

机构地区：[1]复旦大学附属中山医院呼吸内科,上海200032

出　　处：《复旦学报（医学版）》2008年第5期671-674,680,共5页Fudan University Journal of Medical Sciences

基　　金：卫生部部属(管)医疗机构临床学科重点项目(2005-2007);上海市重点学科建设项目(B115)

摘　　要：目的观察急性肺损伤/急性呼吸窘迫综合征(acute lung injury/acute respiratory distress syndrome,ALI/ARDS)患者血浆蛋白C(protein C,PC)活性的改变以及PC、凝血酶调节蛋白(thrombomodulin,TM)和纤溶酶原活化剂抑制物-1(plasminogen activator inhibitor-1,PAI-1)的抗原含量的改变,探讨ALI/ARDS对全身凝血纤溶系统的影响。方法分ALI/ARDS组(24例)和健康对照组(12例)。采用酶联免疫吸附试验(ELISA)分别测定两组静脉血血浆PC、TM、PAI-1的抗原含量,采用发色底物法测定PC活性。对ALI/ARDS患者进行APACHEⅡ及多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)评分。将ALI/ARDS患者依据脏器衰竭的数目和预后进行亚组分析。结果ALI/ARDS组PC活性和PC抗原均低于健康对照组(前者P<0.01,后者P<0.05);TM、PAI-1抗原含量均显著高于健康对照组(P<0.01)。ALI/ARDS组血浆PC活性分别与APACHEⅡ评分和MODS评分存在着显著的负相关性(P<0.01);ALI/ARDS组PAI-1抗原含量与两评分均存在着正相关性(前者P<0.01,后者P<0.05)。ALI/ARDS组PC、TM的抗原含量与两评分均无显著相关性。单纯呼吸衰竭亚组血浆PC活性显著高于MODS亚组(P<0.01);两亚组间PC、TM、PAI-1的抗原含量均无统计学差异。存活亚组和病死亚组间血浆PC活性,PC、TM、PAI-1的抗原含量均无统计学差异。结论ALI/ARDS患者存在着全身凝血纤溶系统的异常改变,即促凝血活性增加和纤溶活性降低;且与疾病的严重程度存在着一定的相关性。Objective To explore the influence of acute lung injury/acute respiratory distress syndrome （ALI/ARDS） on coagulation and fibronolysis system by examining the plasma levels Of protein C （PC）, thrombomodulin （TM） and plasminogen activator inhibitor-1 （PAI-1）. Methods The study was divided into two groups： ALI/ARDS patients （n = 24） and normal volunteers （n = 12）. The plasma levels of PC antigen. TM antigen and PAI-1 antigen were determined by enzyme-linked immunosorbent assay （ELISA）. The plasma level of active PC （APC） was determined by chromogenic substrate method. Furthermore, ALI/ARDS patients were estimated with APACHE Ⅱ score and multiple organ dysfunction syndrome （MODS） score. ALI/ARDS patients were studied by dividing patients into subsets based on the numbers of organ dysfunction and prognosis. Results The plasma levels of APC and PC antigen were significantly lower in patients with ALI/ARDS than those of the normal controls （P〈0.05） ; the levels of TM antigen and PAI-1 antigen were significantly higher in ALI/ARDS patients than those in the normal controls （P〈0. 01 ）. Furthermore, there was a significant negative correlation between the plasma level of APC in patients and APACHE Ⅱ score and MODS score （P〈0.01）; a positive correlation was found between the level of PAI-1 antigen and APACHE Ⅱ score （P〈0.01 ） or MODS score （P〈0. 05）. However, there was no correlation between the levels of PC antigen, TM antigen and APACHE Ⅱ score or MODS score. The plasma level of APC in patients with single lung dysfunction was significantly higher than that in patients with MODS （P〈0.01）; however, there was no difference in the levels of PC antigen, TM antigen and PAI-1 antigen between patients with single lung dysfunction and patients with MODS. The plasma levels of APC, PC antigen,TM antigen and PAI-1 antigen in patients who survived did not differ from those in patients who died. Conclusions The results suggest that there is an increased

关 键 词：急性肺损伤 急性呼吸窘迫综合征 凝血纤溶 蛋白C 凝血酶调节蛋白 纤溶酶原活化剂抑制物-1 

分 类 号：R563.8[医药卫生—呼吸系统]