凝血因子Ⅺ和凝血因子Ⅻ与急性肺栓塞患者疾病严重程度的关系及其作用机制研究  

Relationship between Coagulation FactorⅪ,Coagulation FactorⅫand Severity of Acute Pulmonary Embolism and Its Mechanism

作　　者：孟燕[1] 马强[1] 潘龙飞 秦皓[1] 张波[1] MENG Yan;MA Qiang;PAN Longfei;QIN Hao;ZHANG Bo(Department of Peripheral Vascular Diseases,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Emergency,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]西安交通大学第一附属医院周围血管科,陕西省西安市710061 [2]西安交通大学第二附属医院急诊科,陕西省西安市710004

出　　处：《实用心脑肺血管病杂志》2020年第10期9-13,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：陕西省重点研发计划项目(2017SF-254)。

摘　　要：背景目前临床已知凝血因子Ⅺ(FⅪ)、凝血因子Ⅻ(FⅫ)均与急性肺栓塞(APE)的常见病因——深静脉血栓形成相关,但其在APE发生、发展及抗凝治疗中的作用机制仍不明确且相关研究较少。目的探讨FⅪ、FⅫ与APE患者疾病严重程度的关系及其作用机制。方法选取2018—2019年西安交通大学第一附属医院收治的APE患者45例,均给予华法林抗凝治疗。比较患者治疗前及治疗后2、4、6 d血浆D-二聚体(D-D)、FⅪ、FⅫ水平及肺栓塞严重指数(PESI)分级,并比较治疗前不同PESI分级的APE患者血浆FⅪ、FⅫ水平。采用Pearson相关分析探讨治疗前APE患者血浆FⅪ、FⅫ水平与肺动脉阻塞指数的相关性。结果APE患者治疗后6 d的血浆D-D、FⅪ、FⅫ水平低于治疗前及治疗后2、4 d,PESI分级优于治疗前及治疗后2 d(P<0.05);APE患者治疗后4 d的血浆D-D、FⅪ、FⅫ水平低于治疗前及治疗后2 d,PESI分级优于治疗前(P<0.05);APE患者治疗后2 d的血浆D-D、FⅪ、FⅫ水平低于治疗前(P<0.05)。治疗前PESI分级Ⅴ级的APE患者血浆FⅪ、FⅫ水平高于Ⅰ~Ⅳ级者(P<0.05);治疗前PESI分级Ⅲ、Ⅳ级的APE患者血浆FⅪ、FⅫ水平高于Ⅰ~Ⅱ级者(P<0.05);治疗前PESI分级Ⅱ级的APE患者血浆FⅫ水平高于Ⅰ级者(P<0.05)。Pearson相关分析结果显示,治疗前APE患者血浆FⅪ(r=0.762)、FⅫ(r=0.837)水平与肺动脉阻塞指数均呈正相关(P<0.001)。结论FⅪ、FⅫ活性与APE患者疾病严重程度呈正相关,而抗凝治疗可能会减弱FⅪ、FⅫ对APE患者血栓形成的影响。Background At present,coagulation factorⅪ(FⅪ)and coagulation factorⅫ(FⅫ)are known to be related to deep vein thrombosis,a common cause of acute pulmonary embolism(APE).However,the mechanism of FⅪand FⅫin the the occurrence,development and anticoagulant therapy of APE are still unclear and there are few related studies.Objective To investigate the relationship between FⅪ,FⅫand severity of APE and its mechanism.Methods 45 patients with APE in the First Affiliated Hospital of Xi'an Jiaotong University from 2018 to 2019 were selected,and all patients were given warfarin for anticoagulant therapy.Plasma levels of D-D,FⅪ,FⅫand PESI grade were compared before treatment and 2,4,6 days after treatment,the plasma levels of FⅪand FⅫin APE patients with different PESI grades before treatment were compared.Pearson correlation analysis was used to analyze the correlation between plasma levels of FⅪ,FⅫand pulmonary artery occlusion index in APE before treatment.Results Plasma levels of D-D,FⅪ,FⅫin APE patients at 6 days after treatment were lower than those before treatment,and 2,4 days after treatment,and the PESI grade was better than that before treatment,and 2 days after treatment(P<0.05);plasma levels of D-D,FⅪ,FⅫin APE patients at 4 days after treatment were lower than those before treatment,and 2 days after treatment,and the PESI was better than that before treatment(P<0.05);plasma levels of D-D,FⅪ,FⅫin APE patients at 2 days after treatment were lower than those before treatment(P<0.05).Plasma levels of FⅪ,FⅫin APE patients with PESI gradeⅤwere higher than those in patients with PESI gradeⅠ~Ⅳbefore treatment(P<0.05);plasma levels of FⅪ,FⅫin APE patients with PESI gradeⅢandⅣwere higher than those in patients with PESI gradeⅠ~Ⅳbefore treatment(P<0.05);plasma level of FⅫin APE patients with PESI gradeⅡwas higher than that in patients with PESI gradeⅠbefore treatment(P<0.05).Pearson correlation analysis showed that,plasma levels of FⅪ(r=0.762),FⅫ(r=0.83

关 键 词：肺栓塞 凝血因子Ⅺ 凝血因子Ⅻ 肺动脉阻塞指数 肺栓塞严重程度 

分 类 号：R563.5[医药卫生—呼吸系统]