心脏瓣膜置换术后血栓前体蛋白、D-二聚体在抗凝监测中的应用  

Application of thrombus precursor protein and plasma D-dimer in anticoagulation monitoring after mechanical heart valve replacement

作　　者：张军[1] 万俊哲[1] 张伟[1] 

机构地区：[1]西安交通大学第二附属医院心血管外科,710004

出　　处：《临床外科杂志》2014年第9期682-684,共3页Journal of Clinical Surgery

基　　金：陕西省科学技术研究发展计划项目（2009k16-01）

摘　　要：目的：探索血栓前体蛋白（thrombus precursor protein，TpP）、D-二聚体（D-dimer，D-D）含量与瓣膜置换术后并发症的关系，及其与国际化标准比值（International Normalized Ratio，INR）之间的联系，从而确定其在抗凝治疗监测中的应用价值。方法选择150例机械瓣膜置换术后患者，按有无并发症将患者分为三组：无并发症组（135例），出血组（12例），栓塞组（3例），同时选取健康体检20例为对照组。通过TpP、D-D、INR等指标的检测及随访并发症的结果等情况进行对比，得出相应的结论。结果 TpP检测指标在各组间比较，差异有统计学意义（P 〈0．0083）。D-D在无并发症组（100．96±61．56）、栓塞组（17．78±5．94）和对照组（5．97±1．58）之间比较，差异有统计学意义（P＜0．0083。INR在无并发症组（1．65±0．34）、出血组（2．22±0．65）和对照组（1．11±0．10）之间比较，差异有统计学意义（P＜0．0083），但对于血栓发生的状态其监测有一定的局限性。结论 TpP、D-D检测在瓣膜置换术后具有辅助监测的效果，对确定抗凝治疗具有一定的指导意义，对于瓣膜置换术后并发症的监测具有临床应用价值。Objective To explore the values and relationship among the contents of thrombus precursor protein（TpP）and plasma D-dimer（D-D）,complications after mechanical heart valve replace-ment and their correlation with international normalized ratio（INR）in anticoagulation therapy and monito-ring.Methods A total of 150 patients with mechanical heart valve replacement were enrolled.TpP,D-D, INR,other indicators and complications were compared to draw conclusions.Results There were signifi-cant differences in TpP among the groups（P〈0.0083）.Significant differences in D-D among the postop-erative group（100.96 ±61.56）,thrombosis group（17.78 ±5.94）and control group（5.97 ±1.58）were observed（P〈0.0083）.Significant differences in INR among the postoperative group（1.65 ±0.34）,hem-orrhage group（2.22 ±0.65）and control group（1.11 ±0.10）were observed（P〈0.0083）,but the effec-tiveness of INR monitoring for determining the state of thrombosis was limited to a certain extent.Conclu-sion TpP and D-D examination can facilitate monitoring after mechanical heart valve replacement,and it has a certain guiding significance for determining anticoagulation therapy and monitoring of complications after mechanical heart valve replacement.

关 键 词：心脏瓣膜假体置入 血栓前体蛋白 D-二聚体 抗凝监测 

分 类 号：R654.2[医药卫生—外科学]