内皮细胞因子TM、vWF、凝血因子Ⅶ、Ⅷ和D-二聚体在肝移植排斥反应变化的研究  

A STUDY OF ENDOTHLIL CELL FACTOR TM,vWF,VII FACTOR,VIII FACT OR AND D-DIMER ON LIVER TRANSPLANTATION REJECT REACTION

作　　者：温春光[1] 罗绍凯[1] 何晓顺 李娟[1] 刘敏[1] 刘莉莉[1] 邹外一[1] 彭爱华[1] 

机构地区：[1]中山大学附属第一医院血液内科,广东510080 [2]广东省器官移植研究中心

出　　处：《肝胆外科杂志》2004年第1期47-50,共4页Journal of Hepatobiliary Surgery

基　　金：广州市科技重点攻关项目 ( 97-Z-4 8-0 5 )

摘　　要：目的　为了解肝移植出现排斥反应患者内皮细胞因子、凝血因子和纤溶功能的变化 ,了解这些因素在监测排斥反应、疗效和判断预后的作用。方法　随机观察肝移植 4 1例 ,其中出现排斥反应 1 6例 (急性排斥 1 2例、慢性排斥 4例 )。在术前、术后检测血浆血栓调节蛋白 (STM)、血管性血友病因子 (v WF)、因子 V (FV )、V (FV )和 D-二聚体 (D- D)含量。结果　 1有排斥者术前 FVII含量减少 (6 9.2± 7.2 % ) ,D- D含量则升高 (1 .1 9± 0 .2 0 ng/ L) ;2有排斥者术后、排斥前 2天 FVII进一步减少 (分别为 75 .7± 3.1 ,6 0 .7± 4 .5 ) ,而 STM(分别为 5 .5 8± 0 .4 2 m g/ m l,5 .93± 0 .4 5 ng/ m l)、v WF(分别为 1 0 1 .2± 4 .6 % ,1 0 4 .3± 5 .8% ) ;D- D(分别为 2 .89± 0 .75 ,5 .2 8± 0 .81 )则明显升高 ;3急性排斥较慢性排斥 ,冲击治疗无效组与有效组 ,治疗后死亡组与生存组比较 ,STM和 D- D均明显升高。结论　本研究结果初步显示 :1血浆 STM　 v WF、D- D含量增高和FVII含量减少 ,可作为肝移植排斥早期预报指标 ,其中 STM的特异性最高 ;2血 STM、v WF、D- D和 FVII可作为监测肝移植排斥的实验室检测项目和指标 ;3血 STM和 D- D可作为区分急性与慢性排斥。Objective Investigate the change of endothelial cell factor,coagulation factors and fibrinolysis function in patients undergoing liver transplantation.Find markers of monitoring reject reaction and curative effect,as well as judging prognosis.Methods Observe randomly 41 liver transplantation cases,among which reject reaction 16(acute rejection 12,chronic rejection 4).Measure the levels of plasma soluble thrombomodulin (sTM),von Willebrand factor(vWF),VII factor (FVII),VIII factor(FVIII)and D diner (D D)every other day before and after operation.Result ①The level of FVⅡ decreases befor rejection in patients with reject reaction,the level of FVⅡ decreases more(respectively 75.7±3.1,60.7±4.5),while sTM(repectively 5.58±0.42 ng/ml,5.93±0.45 ng/ml),vWF(respectively 101.2±4.6%,104.3±5.8%)and D D (respectively 2.89±0.75,5.28±0.81) increase significantly,③sTM and D D levels are munch higher in acute rejection than chronic rejection,no reaction group after implosion therapy than effective group,dead group after treatment than living group.Conclusion ①The increasing of plasma sTM,vWF and D D and the decreasing of FVⅡ can be taken as early prediction markers for liver transplantation rejection.The most specific marker among them is sTM;②Plasma sTM,vWF,D D and FVII levels are suitable to be taken as laboratory items of monitoring liver transplantation rejection;3.Plasma sTM and D D can be taken as markers to distinguish acute or chronic reject reaction,monitor implosion therapy effect and judge prognosis.

关 键 词：肝移植 排斥反应 血栓调节蛋白(TM):血管性血友病因子(vWF)因子VⅡ(FVⅡ) 因子VⅢ(FVⅡ) D-二聚体(D-dimer D-D) 

分 类 号：R657.3[医药卫生—外科学]