急性肺血栓栓塞症患者凝血纤溶系统功能变化相关研究  

Determination of Blood Coagulative and Fibrinolytic Systems in Patients with Acute Pulmonary Thromboembolism

作　　者：张锦[1] 杨霞[1] 张红[1] 周玮[1] 李秀忠[1] 

机构地区：[1]宁夏医科大学附属医院呼吸科,银川750004

出　　处：《宁夏医科大学学报》2009年第1期41-42,46,共3页Journal of Ningxia Medical University

摘　　要：目的探讨急性肺血栓栓塞症(acute PTE)患者凝血纤溶系统部分抗凝、促凝因子的变化及其临床意义。方法入选60例急性PTE患者,其中大面积急性PTE 10例,非大面积急性PTE 50例;40例正常人(对照组);采用凝固试验定量检测法测定三组的血浆蛋白C(PC)、血浆蛋白S(PS)活性;采用酶联免疫吸附法(ELISA)测定血栓调节蛋白(TM)。结果PC、PS活性:急性大面积急性PTE组分别为(69.5±21.7)%(、69.1±14.4)%;非大面积组为(93.1±18.8)%(、83.3±18.9)%,均显著低于正常对照组的(105.5±27.7)%、(112.4±28.6)%(P均<0.01);大面积组PC、PS活性显著低于非大面积组(PC:P<0.01,PS:P<0.05)。TM含量:急性大面积肺栓塞组分别为(19.7±10.2)ng/mL,非大面积组为(16.6±10.0)ng/mL,均显著高于正常对照组的(7.5±4.3)ng/mL(P<0.01);大面积和非大面积比较差异无统计学意义。病例组PC、PS阳性率分别为20.0%2、6.7%,明显高于正常对照组的5%、5%(P<0.05),比数比(OR)和95%可信区间依次为4.75(1.16-19.3)、6.9(1.75-27.2)。结论血浆PC、PS活性减低容易发生肺栓塞,PC、PS活性减低的程度与栓塞病情程度有正相关性;血浆TM水平显著增高,提示各种因素引起肺血管内皮损伤是发生PTE的高危因素。Objective To explore the changes of blood coagulative and fibrinolytic systems in patients with acute pulmonaxy thromboembolism（PTE）. Methods 60 patients with acute massive PTE was enrolled, of which 50 patients was acute.non-massive PTE and 10 patients was massive PTE,and 40 control subjects without PTE were included in the study. Plasma protein C（PC） and plasma protein S （PS）activity were measured by the methed of coagulation test quantitation detection, thrombomodulin（TM）, were measured by the method of ELISA. Results The activety of PC and PS were [ （69.5 ± 21.7） %, （69.1 ± 14.4） % ] in patients with acute massive PTE and were [ （93.1 ± 18.8） %, （83.3 ± 18.9） % ] in patients with acute non-massive PTE respectivly . The levels PC and PS of both PIE group were significantly lower than those of the control subjects[（105.5 ± 27.7）%, （112.4 ± 28.6） %, and （P 〈 0.01 ）], the massive PTE group were significantly lower than those of the non-massive PTE, The level of TM were （19.7 ± 10.2）ng/mL in patients with acute massive PTE,and were （16.6± 10.0）ng/mL in patients with acute non-massive PIE, The levels of both PTE group were significantly higher than those of the control subjects[ （7.5 ± 4.3） ng/mL（ P 〈 0.01 ） ]. No significant difference between the massive PTE and non-massive PTE was found . In accordance with normal reference value, if the PC 〈 70%, PS 〈 70%, was considered positive index, the level of PC, PS in case group was 20.0 % （12/60）, 26.7 % （ 16/60 ） respectively, significantly higher than those of control group （ P 〈 0.05）, The OR value and 95 % confidence level was 4.75 （ 1.16 - 19.3）, 6.9 （ 1.75- 27.2） respectively. Conclusion The lower activety of PC and PS,are high risk factors of acute PIE. The level of TM in PPIE group was higher than that of control subjects, which suggest pulmonary vascular endothelium damage occur in patients with PIE.

关 键 词：肺栓塞 蛋白C 蛋白S 血栓调节蛋白 

分 类 号：R563.5[医药卫生—呼吸系统]