小剂量肝素对脓毒症患者血栓烷B_2/6-酮-前列腺素F_(1α)的动态变化及临床意义研究  

Dynamic changes and clinical significance of 6-ketoPGF_(1α) and thromboxane B_2 in low-dose heparin therapy for septic patients

作　　者：何永来[1] 李建华[2] 程青虹[1] 王浩[1] 丁卓奇[2] 帕提曼[2] 徐慧玲[1] 马娟珍[1] 齐妍[3] 

机构地区：[1]新疆石河子大学医学院第一附属医院ICU,新疆石河子832008 [2]新疆喀什地区第一人民医院ICU,新疆喀什844000 [3]新疆石河子大学医学院病理系(第一附属医院病理科),新疆石河子832002

出　　处：《中国现代医学杂志》2015年第5期29-32,共4页China Journal of Modern Medicine

基　　金：国家自然科学基金(No:81202120)

摘　　要：目的探讨小剂量肝素治疗脓毒症中患者血栓烷B2(TXB2)、6-酮-前列腺素F1α(6-keto-PGF1α)表达的动态变化及其临床意义。方法 21例健康体检者为正常对照组。将40例脓毒症患者随机分为对照组(19例)和抗凝组(21例),分别在第1、4、7、10天采集静脉血,用ELISA方法检测3组的TXB2及6-keto-PGF1α的水平,并计算TXB2/6-keto-PGF1α的比值。用生化仪测定血小板(PLT)计数、血浆凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、纤维蛋白原(FIB)的变化,同时观察急性生理学和慢性健康状况Ⅱ(APACHEⅡ)评分,并计算28 d病死率。结果对照组与正常对照组比较,TXB2、6-keto-PGF1α表达明显增加,差异有统计学意义(P<0.05)。抗凝组随着时间的延长TXB2表达、TXB2/6-keto-PGF1α的比值和APACHEⅡ评分均下降,第7、10天与第1、4天比较差异有统计学意义(P<0.05);6-keto-PGF1α轻度上升,差异无统计学意义(P>0.05)。APACHEⅡ评分第10天与第1天比较差异有统计学意义(P<0.05)。而对照组3指标略有上升,但差异无统计学意义(P>0.05)。抗凝组与对照组比较,TXB2和TXB2/6-keto-PGF1α比值在第7、10天差异有统计学意义(P<0.05)。28 d病死率23.8%(5/21)也较对照组26.3%(5/19)降低,但差异无统计学意义(P>0.05)。两组治疗前后PT、APTT、FIB、PLT和D-D值差异无统计学意义(P>0.05)。相关性分析显示,入院时TXB2、TXB2/6-keto-PGF1α比值及APACHEⅡ评分呈正相关(r分别为0.827和0.785,P<0.05)。结论应用小剂量肝素持续泵入治疗脓毒症可显著抑制TXB2,并可降低代表抗凝/促凝的指标TXB2/6-keto-PGF1α比值,有利于机体抗凝/促凝达到平衡,并有可能改善预后,且临床应用安全。TXB2和TXB2/6-keto-PGF1α比值有可能是预测脓毒症病情严重程度的一个新指标。【Objective】To investigate the dynamic changes and clinical significance of 6- keto- PGF1αand thromboxane B2（TXB2） in the low-dose heparin treatment for septic patients.【Methods】 In this study, 21 healthy cases composed of normal control group and 40 septic patients were randomly divided into two groups：routine treatment group（19 cases） and low-dose heparin treatment group（21 cases）. After the treatment for 1,4, 7 and 10 d, the levels of 6- keto- PGF1αand thromboxane B2 were tested by enzyme linked immunosorbent assay（ELISA） in all the three groups, and the ratio of TXB2/6- keto- PGF1αwas calculated. The levels of platelet（PLT）, prothrombin time（PT）, activated partial thromboplastin time（APTT） and fibrinogen were detected by biochemical instrument. At the same time, the score of acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） and 28 d mortality were calculated. 【Results】 The levels of 6- keto- PGF1αand thromboxane B2 in the normal control group were significantly higher than those in the routine treatment group（P 〈0.05）. In the anticoagulation group the TXB2 level, the ratio of TXB2/6- keto- PGF1αand APACHE Ⅱscore decreased as time went by. The levels of the above factors on the day 7, 10 were significantly lower than those on the day 1 and 4（all P 〈0.05）. The level of 6- keto- PGF1αlightly increased, but there was no significant difference between the different groups（P 〉0.05）. The three factors of the normal control group slightly increased, but there was no significant difference between the different groups（P 〉0.05）. The levels of TXB2 and TXB2/6-keto-PGF1αin the anticoagulation group were significantly lower than those in the control group on the day of 7 and 10（P 〈0.05）. In the anticoagulation group the 28 d fatality rate was lower than that in the control group [23.8%（5/21） vs 26.3%（5/19）], but there was no significant difference（P 〉0.05）. The levels of PT, APTT, FIB, PLT and D-D were not signif

关 键 词：肝素 脓毒症 血栓烷B2 6-酮-前列腺素F1Α 

分 类 号：R9[医药卫生—药学] R631