肺血栓栓塞症患者血小板功能和血清抗心磷脂抗体的变化及意义

Changes of the platelet function and serum anticardiolipin antibody in patients with pulmonary thromboembolism

目的 探讨肺血栓栓塞症 (PTE)患者溶栓和抗凝治疗前后血小板功能和血清抗心磷脂抗体 (ACA)的变化及临床意义。方法 选择经螺旋CT肺动脉造影确诊的PTE患者 4 8例为病例组 ,年龄、身高、体重相匹配的健康者 2 0名为对照组。用流式细胞仪检测血小板膜上P 选择素、糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)的变化 ;酶联免疫吸附试验 (ELISA)法检测血浆血栓素B2 (TXB2 )、6 酮 前列腺素F1α(6 Keto PGF1α)、血管性假血友病因子 (vWF)、D 二聚体和血清ACA ,并比较溶栓和抗凝治疗前及治疗 1周时各项指标的变化。结果 病例组P 选择素、GPⅡb/Ⅲa、vWF、TXB2 、D 二聚体、TXB2 / 6 Keto PGF1α(T/K)分别为 (12 4 2± 7 0 3) %、(19 6± 12 5 ) %、(3 8± 1 9)mg/L、(194 5± 2 3 1) %、(341 1±4 2 6 )ng/L、(5 7 3± 19 2 ) ,显著高于对照组的 (2 2 0± 1 5 0 ) %、(1 8± 0 9) %、(0 3± 0 1)mg/L、(99 8± 2 2 8) %、(5 3 7± 16 8)ng/L、(3 4± 1 5 ) ,两组相比差异有显著性 (P均 <0 0 1) ;而 6 Keto PGF1α为(6 7± 2 8)ng/L ,显著低于对照组的 (16 8± 2 6 )ng/L ,差异有显著性 (P <0 0 1)。ACA IgG、IgA显著高于对照组 (P <0 0 1)。PTE患者经治疗 1周后 6 Keto PGF1α较治疗前明显升高 (P

Objective To explore the changes of the platelet function and serum anticardiolipin antibody(ACA) in patients with pulmonary thromboembolism(PTE). Methods Forty-eight patients with PTE diagnosed by spiral computed tomographic pulmonary angiography(CTPA) were included as the trial group, while 20 person in which PTE was excluded served as the control group. P-selectin,and GPⅡb/Ⅲa expressed on platelets were measured by flow cytometry,and plasma TXB 2,6-Keto-PGF1α,vWF,D-dimer and serum ACA were measured by ELISA and the changes of these parameters were compared 1 week later. Results In the trial group, the levels of P-selectin, GPⅡb/Ⅲa,TXB 2, vWF, D-dimer and T/K were significantly higher than those in the control group (P<0.01). But the plasma level of 6-Keto-PGF1α in the patients with PTE was significantly lower than that in the control group (P<0.01). The levels of ACA-IgG and ACA-IgA were significantly higher than those in the control group (P<0.01). After therapy the level of 6-Keto-PGF1α was significantly higher than that before therapy(P<0.01),and other parameters were significantly lower than those before therapy(P<0.01). P-selectin,GPⅡb/Ⅲa and vWF were positively correlated with D-dimer (P<0.01). Conclusion Endothelium damage, platelet activation and hypercoagulation combined with fibrinolytic activation occur in patients with PTE.