胆固醇结石患者胆囊胆汁中凝血和纤溶状态的初步研究  

The relationship between the coagulatic and fibrinolytic properties and the prod uction and degradation of fibrin in gallstone formation

作　　者：秦永林[1] 芦慧霞[2] 韩天权[3] 陈菊[2] 芮宗道[1] 嵇振岭[1] 陈卫东[1] 李国强[1] 王尔慧[1] 张圣道[3] 汤文浩[1] 

机构地区：[1]东南大学医学院附属中大医院普外科,南京210009 [2]东南大学医学院附属中大医院检验科,南京210009 [3]上海第二医科大学瑞金医院外科

出　　处：《中华外科杂志》2001年第5期378-381,共4页Chinese Journal of Surgery

基　　金：教育部高等学校骨干教师资助计划资助项目![( 2 0 0 0 )65 ]

摘　　要：目的　通过研究胆固醇结石患者胆囊胆汁中凝血纤溶状态与交联纤维蛋白生成和降解的关系来探讨胆囊结石的形成机制。　方法　收集胆固醇结石 (简称胆石 )患者胆囊胆汁 2 0份和非胆囊结石患者胆囊胆汁 15份 ,测定胆汁中的纤维蛋白特异性降解产物D 二聚体抗原和部分凝血纤溶因子抗原和活性水平。　结果　胆囊结石组患者胆汁中D 二聚体抗原高于非胆囊结石组 (P <0 0 1) ,抗凝血酶Ⅲ抗原高于非胆囊结石组 (P <0 0 5 ) ,抗凝血酶Ⅲ活性低于非胆石组 (P <0 0 5 ) ,胆石组抗凝血酶Ⅲ抗原与活性之比与非胆石组相比明显增高 (P <0 0 1) ,胆石组纤溶酶活性较非胆石组增高 (P <0 0 5 ) ,纤溶酶活性与凝血活性指标之比明显低于非胆石组 (P <0 0 5 ) ,两组间纤溶酶原激活物抑制物活性差异无显著性。　结论　胆固醇结石患者胆囊胆汁中的凝血和纤溶活性均高于非胆石组 ,但纤溶活性增高的程度与凝血活性相比则明显减低 ,从而使交联纤维蛋白的生成增多 ,而降解相对减少 ,导致成石组胆囊胆汁中交联纤维蛋白积累 ,促进胆囊结石的形成。Objective To study the effects o f coagulatic and fibrinolytic activities on production and degradation of fibrin in normal and calculous human bile. Methods Coagulatic and fibrinolytic components and D Dimer antigen were studied in the biles of patients with gallstones (20 patients) compared with those without gall stones (15). Results D Dimer was significantl y higher in gallstones group than in controls (median 1 260 mg/L, vs. 0 234 mg /L, P <0 01). the concentration of antithronbin Ⅲ antigen (AT Ⅲ: Ag) wa s higher in the biles of patients with gallbladder stones than those without ga llstones (median 425 45 mg/L, vs. 163 64, P <0 05). On the contrary, th e activity of antithrombin Ⅲ (AT Ⅲ: Ac) was lower than in controls (median 11 5 73%, vs. 162 65%, P <0.05). There was a significant difference in the r atio of AT Ⅲ:Ag to AT Ⅲ:Ac in both groups (median 8 47, vs. 0 97, P <0 01). The activity of plasmin (Plm:Ac) was greater in gallbladder bile of c alculous patients than in that of those without gallstones (median 62 83%, vs. 49 95%, P <0 05), but the ratio of fibrinolytic activity to coagulatic ac tivity was much lower in patients with gallbladder stones than in those without gallstones (median 7 4, vs. 38 6, P <0 02). There was no significant dif ference in the activity of plasminogen activator inhibitor (PAI: Ac) in both gro ups (median 0 368%, vs. 0 678%). Conclusions Both coagulatic and fibrinolytic activities were much greater in patients with gallbladder stones than in those without gallstones, but the increment of fibri nolytic activity was lower than that of coagulatic activity. Then the producti on of crosslinked fibrin would be reinforced in the gallbladder bile of patients with gallstones. Simultaneously, the degradation of crosslinked fibrin also inc reased in gallstone patients, resulting from the soaring of the fibrinolytic act ivity. But the increment of degradation was relatively lower then that of the pr oduction of crossli

关 键 词：胆结石 胆固醇 抗凝血酶Ⅲ 纤维蛋白溶解 

分 类 号：R657.42[医药卫生—外科学]