严重急性呼吸综合征后激素性骨坏死患者的凝血和纤溶指标观察

Abnormalities of blood coagulation and fibrinolysis in patients with steroid induced osteonecrosis after severe acute respiratory syndrome

目的观察严重急性呼吸综合征(SARS)使用激素的骨坏死患者血液血栓形成和低纤溶倾向的指标变化,探讨SARS后骨坏死的病因学,以便用于非创伤性骨坏死的早期诊断和易感人群的筛选。方法选取88例SARS后激素性骨坏死患者抽取空腹肘静脉血。另取健康人群52名为对照,应用凝血仪和酶标仪的酶联免疫吸附法等方法测定凝血和纤溶指标。结果SARS后激素性骨坏死患者血液学因素改变明显,骨坏死组蛋白C(PC)(89±32)%,抗凝血酶Ⅲ(AT-Ⅲ)(87±27)%,纤溶酶原激活物抑制剂(PAI)(18±15)U/M L,纤溶酶原(PLG)(73±24)%,而对照组分别是PC(109±20)%,AT-Ⅲ(104±15)%,PAI(8±4)U/M L,PLG(95±15)%,两组比较差异有统计学意义(P<0.01)。在各指标出现异常的人数上,骨坏死组PC 25例(占28.41%),活化蛋白C抵抗(APCR)11例(12.6%),AT-Ⅲ39例(44.82%),PAI 46例(52.27%),PLG 52例(59.09%);而对照组PC 2例(3.85%),APCR 1例(1.92%),AT-Ⅲ2例(3.85%),PAI 5例(9.62%),PLG 3例(5.77%),差异有统计学意义(P<0.05)。结论SARS后骨坏死患者的凝血、纤溶指标异常,对骨坏死易感人群可以进行高凝和低纤溶的筛选,PC、AT-Ⅲ、PAI、APC-R、PLG可作为骨坏死易感因素的筛选指标。

Objective To study the changes of blood coagulation and fibrinolysis in patients with steroid induced osteonecrosis after severe acute respiratory syndrome （post-SARS） and its etiology, for early diagnosis of non-traumatic osteonecrosis, and screening for its susceptible population. Methods Eightyeight patients with post-SARS osteonecrosis and 52 healthy people as normal controls were selected. Fasting blood specimens were collected from their cubital veins for measuring activated partial thromboplastin time （ APTT）, protein C （ PC ）, antithrombin Ⅲ （ AT-Ⅲ ）, plasminogen activator inhibitor （PAI ）, activated protein C resistance （APC-R） , plasminogen （PLG）, yon Willebrand factor （vWF）, D-Dimer （D-D） and fibrinogen （Fib） by ELISA, and homocysteine （tHCY） by chromatography. Results Hematologic indicators changed obviously in patients with post-SARS osteonecrosis with PC of （ 89 ± 32 ） %, AT- Ⅲ （87 ± 27） %, PAI（ 18 ± 15） U/ml and PLG （95 ± 15 ） % , as compared to those in controls with PC of （109±20） %, AT-Ⅲ （104±15） %, PAI （8±4） U/ml and PLG （95±15） %, （P 〈0.01）. Frequency of abnormalities of blood coagulation and fibrinolysis in osteonecrosis group was as follows, 28.41% for PC （25 cases）, 12. 6% for APCR （11 cases）, 44. 82% for AT-Ⅲ （39 cases） , 52. 27% for PAI （46 cases） and 59.09% for PLG （52 cases）, as compared to that in controls 3.85% for PC （2 cases）, 1.92% for APCR （one case）, 3.85% for AT-Ⅲ （2 cases）, 9.62% for PAI （5 cases） and 5.77% for PLG （3 cases）, （ P 〈 0. 05 ）. Conclusions Hypercoagulation and hypofibrinolysis were found in patients with post-SARS osteonecrosis, which could be used to screen for those at high risk of nontraumatic osteonecrosis with several sensitive indicators such as APTT, PC, AT-Ⅲ, PAI, APC-R and PLG.