急性肺血栓栓塞症患者部分凝血纤溶功能变化的相关研究  

Changes of blood coagulative and fibrinolytic systems in patients with acute pulmonary thromboembolism

作　　者：杨霞[1] 韩玉霞 张锦[1] 侯嘉[1] 谭海[1] 张红[1] 

机构地区：[1]宁夏医科大学附属医院,宁夏银川750004 [2]宁煤石嘴山中心医院,宁夏石嘴山753200

出　　处：《宁夏医学杂志》2009年第12期1104-1106,共3页Ningxia Medical Journal

基　　金：宁夏回族自治区教育厅资助项目

摘　　要：目的探讨急性肺血栓栓塞症(acutePTE)患者血浆同型半胱氨酸(HCY)、抗心磷脂抗体(ACA)、纤溶酶原激活剂抑制物-1(PAI-1)、组织型纤溶酶原激活剂(t-PA)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10例,非大面积50例;40例正常人(对照组);采用酶联免疫吸附法(ELISA)测定HCY、PAI-1、t-PA血清含量及ACA定性(阳性、阴性)。结果HCY、PAI-1、t-PA含量:急性大面积肺栓塞组、非大面积组均显著高于正常对照组(分别P<0.01);大面积和非大面积比较差异无统计学意义。以高同型半胱氨酸血症(hightotalhomocystein,HHcy)、PAI-1>28ng/ml、ACA阳性为阳性指标,病例组HHcy、PAI-1、ACA阳性率明显高于正常对照组(分别P<0.05);病例组t-PA、PAI-1均增高,且呈直线相关性。结论ACA阳性、PAI-1水平增高、HHcy是急性PTE高危因素;病例组t-PA、PAI-1均增高,两者之间有明显相关性,考虑急性肺血栓栓塞症致病因素不是t-PA抗原产生和释放不足,而是PAI-1抗原水平增高更加显著。Objective To explore the changes of blood coagulative and fibrinolytic systems in patients with acute pulmonary thromboembolism （PTE）.Metheds 60 patients with acute massive PTE were enrolled,of which 50 patients were acute.non-massive PTE and 10 patients were massive PTE,and 40 control subjects without PTE were included in the study.Homocysteine （Hcy）,tissue-type plasminogen activator （t-PA）,plasminogen activator inhibitor-1（PAI-1） were measured by the ELISA method.Anticardiolipin antibody （ACA） was detected by ELISA method.Results The level of HCY,PAI-1,t-PA were respectively（26.2±8.0）umol/ml,（25.1±12.0）ng/ml,（11.7±8.8）ng/ml in patients with acute massive PTE,and were（18.4±12.2）umol/ml,（24.2±9.7）ng/ml,（10.2±6.3）ng/ml in patients with acute non-massive PTE,The levels of both PTE group were significantly higher than those in the controls.No significant difference between the massive PTE and non-massive PTE was found.Positive rate of ACA in patients with acute PTE was （18/60）,significant higher than that in control group （P0.01）.The level of Hcy,PAI-1 and positive rate of ACA in case group were respectively 58.3 （35/60）,36.7 （22/60）,30.0 （18/60）.It was significantly higher than those of control group （P0.05）,The OR value and 95% confidence level were respectively 26.6 （8.16-86.6）,22.6 （4.47-114.3） and 3.86 （1.25-11.8）.The level of t-PA,PAI-1 in case group and control group increased significantly and showed linear correlation.Conclusion Positive ACA,increase of PAI-1 and HHcy are risk factors of acute PTE.

关 键 词：肺栓塞 同型半胱氨酸 抗心磷脂抗体 组织型纤溶酶原激活剂 纤溶酶原激活剂抑制物-1 

分 类 号：R563.5[医药卫生—呼吸系统]