凝血酶原前体蛋白血浆浓度在患者出院后抗凝监测中的意义

SIGNIFICANCE OF PLASMA PIVKA-II CONCENTRATION IN ANTICOAGULATION MONITORING OF PATIENTS WITH MECHANICAL HEART VALVE REPLACEMENT

目的进一步探讨凝血酶原前体蛋白(proteins induced by vitamin K absence or antagonism,PIVKA-II)血浆药物浓度动态变化在心脏机械瓣膜置换术后抗凝监测中的临床意义。方法随机选择30例风湿性心脏病行机械瓣膜置换术的患者,同步测定PIVKA-II血浆药物浓度、国际标准比值(international normalized ratio,INR)、凝血酶原时间(prothrombin time,PT)和华法林服用剂量的动态变化,同时观察抗凝并发症的发生情况。结果①PIVKA-II血浆药物浓度在患者出院后3、6个月、1年保持相对稳定,与出院前相比无显著变化(P>0.05)。②INR和PT在患者出院前后相比无显著变化(P>0.05)。③PIVKA-Ⅱ血浆浓度与INR及PT呈显著正相关。结论PIVKA-II血浆药物浓度灵敏而稳定,其与INR及PT等抗凝监测指标结合有助于提高抗凝监测的准确性,减少抗凝并发症的发生。

Objective To study the clinical significance of plasma proteins induced by vitamin K absence or antagonism（PIVKA-Ⅱ） concentration in oral anticoagulation monitoring following mechanical heart valve replacement. Methods Thirty patients following mechanical heart valve replacement were chosen randomly. They all had rheumatic heart disease. Plasma concentration of PIVKA-Ⅱ,international normalized ratio（INR）, prothrombin time（PT） and oral dosage of warfarin were determined respectively. At the same time,the clinical complications,such as blooding and thromboembolism were observed. Results ① The plasma PIVKA-Ⅱ concentration had no significant change （ P 〉0.05） three months,six months and one year after surgery. ②No significant changes were found between the period in hospital and that after the patients were discharged from the hospital. ③There were significant correlations between plasma PIVKA-Ⅱ concentration with INR and PT. Conclusion The plasma concentration of PIVKA-Ⅱ was a sensitive index in monitoring anticoagulation. The combination of plasma PIVKA-Ⅱ concentration with INR and PT could improve the monitoring of antieoagulation effects.