慢性阻塞性肺疾病患者凝血功能异常与氧化应激的关系  

The relationship between coagulation/anticoagulation imbalance and oxidative stress in patients with chronic obstructive pulmonary disease

作　　者：黄瑾[1] 刘晓菊[1] 包海荣[1] 张艺[1] 谭恩丽[1] 廖剑敏[1] 

机构地区：[1]兰州大学第一医院老年呼吸科,730000

出　　处：《中华内科杂志》2011年第8期664-667,共4页Chinese Journal of Internal Medicine

基　　金：国家自然科学基金（81070038）

摘　　要：目的 探讨慢性阻塞性肺疾病（COPD）急性加重（AECOPD）患者凝血功能异常与氧化应激的关系.方法 选28例AECOPD患者和30例健康对照者,检测其血浆中组织因子（TF）、组织因子途径抑制剂（TFPI）活性、总抗氧化能力（TAC）、丙二醛（MDA）、谷胱甘肽过氧化物酶（GSH-PX）活性及肺功能,并行动脉血气分析.结果 （1）与治疗前比较,AECOPD患者治疗后血浆TF、TFPI、TF/TFPI水平均明显下降（P〈0.01）,但仍高于健康对照者（P〈0.01）.（2）与治疗前比较,AECOPD患者治疗后血浆TAC、GSH-PX水平虽升高,但仍低于健康对照者;治疗后血浆MDA水平下降,但仍高于健康对照者（P〈0.05）.（3）相关分析：AECOPD患者治疗前TF/TFPI与血浆TAC、GSH-PX、PaO2呈负相关（r分别为-0.518、-0.454、-0.511;P〈0.01,P〈0.05,P〈0.01）,与中性粒细胞百分比呈正相关（r=0.379,P〈0.05）;而AECOPD患者治疗后TF/TFPI与血浆TAC、第1秒用力呼气容积占预计值百分比呈负相关（r分别为-0.420、-0.480;P值均小于0.05）,与血浆MDA呈正相关（r=0.451,P〈0.05）.结论 AECOPD患者存在凝血/抗凝失衡及氧化/抗氧化失衡,凝血/抗凝失衡与氧化/抗氧化失衡之间存在显著相关性.Objective To explore the relationship between coagulation/anticoagulation imbalance and oxidative stress in the patients with chronic obstructive pulmonary disease during acute exacerbation （AECOPD）before and after treatment.Methods Plasma tissue factor（TF）and tissue factor pathway inhibitor（TFPl）activity was detected by chromogenic assay in 28 AECOPD patients before and after treatment as well as in 30 healthy controls.The total antioxidative capacity（TAC）,malondialdehyde （MDA）and gtutathione peroxidase（GSH-PX）in plasma were measured in both groups.Results The levels of plasma TF and TFPI,and their ratio（TF/TFPI）in AECOPD patients before treatment were significantly higher than those after treatment（all P〈0.0 1）,the latter were still higher than those in the healthy persons（all P〈0.01）.The levels of the TAC and GSH-PX in plasma in AECOPD patients before treatment were significantly lower than those after treatment（all P〈0.01）,the latter were still lower than those in the healthy persons（all P〈0.01）.The plasma MDA in AECOPD patients before treatment was significantly higher than that after treatment（P〈0.0 1）,which was still higher than that in the healthy persons（P〈0.05）.There were negative correlations between TF/TFPI ratio and TAC（r=-0.518.P〈0.01）,GSH-PX（r=-0.454,P〈0.05）,PaO2（r=-0.511,P〈0.01）respectively and a positive correlation between TF/TFPI ratio and the percentage of neutrophils（r=0.379,P〈0.05）in AECOPD patients before treatment.There still were negative correlations between TF/TFPI ratio and TAC （r=-0.420,P〈0.05）,FEV1% to predicted（r=-0.480,P〈0.05）respectively,and a positive correlation between TF/TFPI ratio and MDA（r=0.45 1,P〈0.05）in AECOPD patients after treatment.Conclusions There existed coagulation/anticoagulation imbalance and oxidation/antioxidation imbalance before and after treatment in AECOPD patients and their relationship was explored.

关 键 词：肺疾病 慢性阻塞性 凝血致活酶 氧化性应激 

分 类 号：R563.9[医药卫生—呼吸系统]