体外循环围术期血浆高敏C反应蛋白和血栓调节蛋白变化的临床研究

The changes level and clinical value of plasma hypersensitive C-reactive protein and thrombomodulin around cardiopulmonary bypass

目的探讨体外循环血管内皮细胞损伤对血小板活化的影响。方法将20例体外循环手术病例分别在手术开始(T1)、手术结束(T2)、术后1d(T3)、术后3d(T4)、术后7d(T5)共5个时间点采取外周静脉血,采用免疫比浊法测定血浆中高敏C反应蛋白、双抗体夹心酶标免疫分析法测定标本血浆中血栓调节蛋白的浓度。结果血浆血栓调节蛋白在T2与T3之间达到高峰,高敏C反应蛋白在T3达峰值,而后均逐渐下降,T5时血栓调节蛋白、高敏C反应蛋白仍高于T1水平,并具有统计学意义(P<0.05);血栓调节蛋白与高敏C反应蛋白呈正相关(r=0.516)。结论体外循环手术存在全身炎症反应引起的血管内皮细胞和血小板损伤,血管内皮细胞损伤与血小板损伤存在明显正相关。

Objective To explore the effect of vascular endothelial cells damaged to platelets activation around cardiopulmonary bypass(CPB).Methods Twenty patients following date-selective open-heart surgery by CPB were enrolled at admission(n=20).Blood samples were collected at 5 time points pre-operation(T1),end-operation(T2),one day after operation(T3),three days after operation(T4)and seven days after operation(T5),and tested plasma levels of HsCRP and Tm.HsCRP is as a sign of the endothelial cell damage,it was tested by using immunonephelometry method.Tm is as a marker of the platelet cell activation,it was tested by using double antibody sandwich enzyme-immunoassay method.The changes of the plasma levels of these two markers of the group at different time points were analyzed and compared with eatch other,to explore respectively the correlations about of the level of HsCRP and TM.Results Compared the plasma level of all the markers in the group,there are significantly increased with respect to baseline(T1) from before operation to seven postoperative days;the plasma concentration of TM in the group is its peak between T2 and T3,the level of HsCRP is its peak at T3,then decreased.But they are still higher than that in the study group’s baseline(T1) at T5(P&lt;0.05).The corelations betwen TM and HsCRP resprectively is obvious positive(r=0.516).Conclusions Surgical procedures such as cardiopulmonary bypass cause many adverse postoperative complications,it makes vasular endothelial and platele cell damaged.The corelation between vasular endothelial and platele cell damage is obvious positive.