深静脉血栓患者溶栓前后血栓分子标志物的变化研究

Study on the variations of thrombus molecule marker in patients with deep vein thrombosis before and after thrombolytic therapy

目的观察深静脉血栓(DVT)患者溶栓前后血栓分子标志物水平的变化,以探讨凝血、纤溶活性改变与DVT患者溶栓后高血栓复发率及疗效的相关性。方法采用发色底物法、免疫比浊法和酶联免疫法分别测定55例DVT患者溶栓前后血浆标本的抗凝血酶活性(AT:A)、纤溶酶原活性(PLG:A)、组织型纤溶酶原激活物抗原性(t-PA:Ag)、纤溶酶原活性抑制剂-1抗原性(PAI:Ag)、血浆D-二聚体(D-D)、血管性血友病因子(vWF)、血浆血栓调节蛋白(TM:Ag)、VIII促凝活性(Ⅷ:c);35例健康体检者作对照。结果AT:A、PLG:A、t-PA:Ag在溶栓前明显低于对照组(P<0.01),溶栓后升高(P<0.05或P<0.01),其中AT:A、PLG:A仍低于对照组(P<0.05或P<0.01),而t-PA:Ag无显著性差异(P>0.05);PAI:A、D-D、VIII:C、vWF、TM:Ag在溶栓前显著高于对照组(P<0.01),溶栓后下降(P<0.05或P<0.01),其中PAl:A、D-D、VIII:C、vWF、TM:Ag仍明显高于对照组(P<0.05或P<0.01)。痊愈组AT:A、PLG:A、TM:Ag水平与正常对照组无显著性差异(P>0.05),D-D下降幅度最大。结论血栓分子标志物水平可反映患者疗效,凝血系统机能紊乱、纤溶-抗纤溶系统失衡与DVT患者溶栓后血栓的复发可能有密切的关系。

Objective To observe the changes of thrombus molecule marker in patients with deep vein thrombosis（DVT） before and after thrombolytic therapy.Methods Blood samples from 55 patients with deep veins thrombosis before and after thrombolytic therapy and 35 normal people（control group） were obtained to determine the levels of antithrombin activity（AT：A）,plasminogen activity（PLG：A）,von willabrand factor（VWF）,FVⅢ coagulant activity（VⅢ：C）,thrombomodulin（TM：Ag）,D-dimer（D-D）,tissue plasminogen activator antigen（t-PA：Ag）,plasminogen activator inhibitor-1 antigen（PAI：Ag） respectively by chromophore substrate methods,immunoturbidimetery and ELISA.Results The levels of AT：A,PLG：A,t-PA：Ag after treatment were significantly lower than that before treatment（P〈0.01） and it increased after therapy（P〈0.05 or P〈0.01）,the AT：A,PLG：A was still lower than that of control group（P〈0.05 or P〈0.01） and t-PA：Ag changed insignificantly（P〉0.05）.The levels of PAI：A,D-D,VIII：C,vWF,TM：Ag in patients with DVT were significantly higher than that of before treatment（P〈0.01） and these parameters decreased quickly after therapy（P〈0.05 or P〈0.01） while the levels of PAl：A,D-D,VIII：C,vWF and TM：Ag were still higher than control group（P〈0.05 or P〈0.01）.The levels of AT：A,PLG：A,t-PA：Ag in recovery group were not significantly different compared to that of control group,but the level of D-D was decreased.Conclusion The changes of thrombus molecule markers reflect the therapeutic effect and the disorder of procoagulant,anticoagulant,fibrinolysis and antifibrinolys consanguineously maight be associated with high-frequency occurrence of thrombosis DVT patients after thrombolytic therapy.