治疗深静脉血栓形成过程中活化蛋白C和D-二聚体的改变

Change of Activated Protein C and D-dimer in the Treatment of Deep Venous Thrombosis

目的观察深静脉血栓形成(DVT)发病时和两种治疗[尿激酶和重组组织型纤溶酶原激活剂 (rt-PA)]过程中活化蛋白C(APC)和D-二聚体(D-D)的变化及其意义。方法确诊的30例DVT随机分为:A组(15例),用尿激酶治疗;B组(15例),用rt-PA治疗。治疗过程中4次采血观察血浆APC和D-D水平。普通住院术前患者为对照组(10例),不采用药物治疗,入院时采血观察血浆APC和D-D水平。结果治疗前A、B组血浆APC水平与照组相比明显降低(P<0．01),血浆D-D水平则明显升高(P<0．01)。治疗过程中,A、B组血浆APC水平均明显升高;A组血浆D-D含量无明显变化(P>0．05),B组D-D含量明显降低(P<0．05),A组和B组之间的疗效无明显差异(P>0．05)。不同的发病时间其治疗效果有明显差异(P<0．05)。结论 APC和D-D对DVT有早期诊断价值;APC可能提示病情的严重程度,D-D无此作用。用常规剂量尿激酶和rt-PA治疗DVT的疗效无差异;治疗效果好的患者发病时间一般较短。

Objective To observe the change of activated protein C（APC） and D-dimer（D-D） in the treatment of deep venous thrombosis（DVT）. Methods 30 patients who had been diagnosed as DVT were randomly divided into two groups： group A （15patients）treated with urokinase and group B（15patients ）with rt-PA. APC and D-D level were identified four times during the treating procedure. 10 other patients （receiving no medicine） in control group were given test on APC and D-D level at admission check-up. Results Before treatment,the blood APC level of patient group was significantly lower than that of control group（P 〈 0.01 ）and the blood D-D level was significantly higher （P 〈 0.01）.During the treatment procedure, the blood APC level of group A and group B was significantly higher than before treatment,and the blood D-D level of group A was not significantly lower than before treatment （P 〉 0.05）,while the blood D-D level of group B was significantly lower than before treatment （P 〈 0.05）. The curative effect between group A and group B was not significantly different （P 〉 0.05）. The curative effect of different morbidity time was significantly different（P 〈 0.05）. Conclusion Investigating blood APC and D-D level is important for early diagnosis of DVT. Blood APC level may express serious degree of DVT while blood D-D level does not .The curative effects between common dosage urokinase and rt-PA in healing DVT is not significantly different （P 〉 0.05）. The curative effect is positive in shorter course of the disease.