慢性阻塞性肺疾病急性期凝血纤溶系统功能变化的临床研究

A study on abnormality of coagulation and fibrinolytic system in patients with COPD at acute stage

目的探讨慢性阻塞性肺疾病(COPD)凝血纤溶功能异常的可能机制。方法选择北京朝阳医院2006—2007年慢性阻塞性肺疾病急性期(AECOPD)住院患者38例,并选择同期47名健康体检者做对照,入选者采用酶联免疫吸附试验(ELISA)测定血浆血管性血友病因子(vWF)、组织因子(TF)、组织因子途径抑制物(TFPI)、凝血因子X、血栓调节蛋白(TM)、蛋白C、组织型纤溶酶原激活物(tPA)、纤溶酶原激活剂抑制物-1(PAI-1)及D-二聚体(D-dimer),发色底物法测定抗凝血酶Ⅲ(AT-Ⅲ)。测定AECOPD患者血气分析、血常规、血脂、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及血浆纤维蛋白原(FBG)等指标。结果与对照组比较,AECOPD患者vWF、TF、凝血因子Ⅹ、D-dimer及tPA显著升高(P<0.01);TM及蛋白C显著下降(P<0.01)。而两组的AT-Ⅲ、TFPI及PAI-1比较,差异无统计学意义。结论AECOPD患者存在显著凝血纤溶功能失衡状态,在诊治AECOPD患者时,要充分考虑到患者存在的凝血纤溶功能异常,要注意监测相关凝血纤溶指标,对防治AECOPD有重要意义。

Objective To discuss possible mechanism of chronic obstructive pulmonary disease （COPD） coagulation and fibrinolysis dysfunction. Methods Totally 47 healthy controls （ Group A） and 38 cases of AECOPD （ Group B） were chosen respectively. The plasma levels of vWF, Factor X, TF, TFPI, TM, PC, tPA, PAI-1 and D-dimer were measured by ELISA method, and the blood AT-Ⅲ activity was measured by chromogenic assay. The cases of Group B were measured for RBC,WBC,PLT,PH,PaO2,PaCO2,HCO3- ,PT,APTT,FBG,and so on. Results The plasma levels of vWF,TF,Factor X, t-PA and D-dimer in Group B were significantly higher than those in Group A while TM and PC were significandy lower in Group B （ P 〈 O. O1 ）. AT-Ⅲ, PAI-1 and TFPI levels in group A were not significantly different from Group B. Conclusion Abnormality of coagulation and fibrinolytic system exists in AECOPD. The application of prophylactic anticoagulant therapy, or even the prophylactic thrombolytic therapy, might become potential in the majority of AECOPD cases.