凝血因子和抗凝蛋白检测诊断急性静脉血栓栓塞症  

Coagulation factors and anticoagulant protein assay for the dignosis of acute venous thromboembolism

作　　者：邓昊昱[1] 陈佳佺[1] 谢辉[1] 袁凯[1] 沈薇[2] 顾怡[2] 张皓[1] 张纪蔚[1] 张岚[1] 

机构地区：[1]上海交通大学医学院附属仁济医院血管外科,200127 [2]上海交通大学医学院附属仁济医院检验科,200127

出　　处：《中华普通外科杂志》2013年第3期222-225,共4页Chinese Journal of General Surgery

基　　金：上海市科委自然科学基金资助项目（10ZR1418800）;仁济医院第四期学科建设基金资助项目（RJ4101309）

摘　　要：目的探讨急性静脉血栓栓塞症（venousthromboembolism，VTE）患者凝血因子与抗凝蛋白水平对评估其患病风险的影响和意义。方法采用一期凝固法、发色底物法，检测76例急性静脉血栓栓塞症患者（VTE组）和81例健康对照人群（对照组）的凝血因子活性（FⅡ、FⅤ、FⅦ、FⅧ、FⅨ、FⅩ、FⅪ、FⅫ），抗凝蛋白（antithrombinactivity）AT、Pc活性。结果（1）VTE组与健康对照组凝血因子与抗凝蛋白值的比较：VTE组FⅡ、FⅤ、FⅧ、FⅨ、FⅩ、FⅪ和FⅫ均较健康对照组显著升高，差异有统计学意义（P〈0．01）。VTE组PC值较健康对照组显著降低，差异有统计学意义（P〈0．01）。VTE组AT、FⅦ值与健康对照组相比，差异无统计学意义（P〉0．05）。（2）Logistic回归分析显示：VTE主要危险因素为FⅧ、FX活性异常升高、PX活性异常下降，与健康对照组相比，差异均有统计学意义（P〈0．05）。（3）用ROC曲线分析：FⅧ、FⅩ和PC对VTE早期诊断的价值，FⅧ、FⅩ和PC的AUC值分别为：0．934、0．765和0．350。结论除FⅦ因子外，其余凝血因子活性异常升高与急性VTE显著相关，其中FⅧ敏感性、特异性最大，对于诊断急性VTE价值最大。FⅧ活性异常增高与PC活性异常降低是急性VTE独立危险因素。Objective To analyze the variation of-coagulation factors and anticoagulant proteins in acute venous thromboembolism （VTE） and explore the significance of coagulation factors and anticoagulant protein in early diagnosis of VTE and their role in predicting risk factors. Methods In this study, 76 VTE cases were enrolled. 81 cases served as healthy controls. Full automatic coagulation analyzer was used to determine the activity of coagulation factors （FⅡ,FⅤ,FⅦ,FⅧ,FⅨ,FⅩ,FⅪ, and FⅫ）. Chromogenic substrate method was used to detect the activity of AT and PC. Results （ 1 ） In VTE group, the levels of FⅡ、FⅤ、FⅧ、FⅨ、FⅩ、FⅪand FⅫ were higher than those in healthy control group（P 〈 0. 01 ）. PC activity decreased significantly compared with healthy controls （ P 〈0. 01 ）. There was no statistical difference between VTE and healthy controls in FⅦ and AT activity. （2） Logistic regression indicated that the main risk factors of VTE were abnormal activity of FⅧ, FⅩ and PC by a statistical difference （ P 〈 0. 05 ）. （3） ROC curve was used to analyze the vaule of F Ⅷ. FⅩ and PC for early diagnosis of VTE,AUC of FⅧ,FXand PC were 0. 934,0. 765, 0. 350 respectively. Conclusions Except FⅦ, abnormally increased levels of all coagulation factors were significantly associated with acute VTE. Decreased PC activity and increased activity of FⅧ were independent risk factors for acute VTE. Among all, FⅧ is the most valuable by its higher specificity and susceptibility for early diagnosis of VTE.

关 键 词：静脉血栓栓塞 血液凝固因子 蛋白质C ROC曲线 

分 类 号：R543.6[医药卫生—心血管疾病]