荨麻疹患者血浆D二聚体、活化凝血因子Ⅶ及组织因子途径抑制物-活性凝血因子X复合物与症状的关系

Relationship of clinical symptom to plasmic levels of D-dimer, activated factor Ⅶ and tissue factor pathway inhibitor （TFPI）/X a in patients with urticaria

目的探讨荨麻疹患者血浆D二聚体、活化凝血因子（FⅦa）、TFPI／Xa水平与症状的关系。方法酶联免疫吸附法检测急、慢性荨麻疹患者和健康献血者血浆D二聚体、FⅦa、TFPI／Xa的水平，分析它们之间及其与症状评分、病程的关系。结果急性荨麻疹患者的血浆D二聚体水平（450．57±242．13）ng／mL高于正常人对照组（266．81±40．68）ng/mL。血浆FⅦa水平（2．23±0．74）ng/mL低于正常人对照组（5．23±1．35）ng/mL，组间比较差异均有统计学意义（P〈0．01）。急性荨麻疹患者血浆TFPI／Xa水平（0．87±0．13）nmol／L与正常人对照组（0．88±0．12）nmol/L比较，组间差异无统计学意义（P〉0．05）。慢性荨麻疹患者的血浆D二聚体水平（593．80±294．04）ng／mL高于正常人对照组，组间比较差异有统计学意义（P〈0．01）；慢性荨麻疹患者血浆FⅦa水平（3．98±0．35）ng／mL低于正常人对照组，组间比较差异有统计学意义（P〈0．01）。慢性荨麻疹患者血浆TFPI／Xa水平（0．87±0．16）nmol／L与正常人对照组比较，组间差异无统计学意义（P〉0．05）。急性荨麻疹患者D二聚体水平和FⅦa水平低于慢性荨麻疹患者，组间比较差异均有统计学意义（P〈0．05）。急、慢性荨麻疹患者血浆D二聚体与症状评分呈正相关关系（r=0．68，P〈0．01；r=0．82，P〈0．01），与病程无明显相关性（P〉0．05），FⅦa和TFPI／Xa水平与症状评分关系及病程无明显相关性（P〉0．05）。结论荨麻疹患者存在凝血系统激活和凝血因子消耗及继发性纤溶，提示D二聚体、FⅦa可能与荨麻疹症状有关。

Objective To evaluate the relationship of clinical symptom to plasmic levels of D-dimer, activated factor Ⅶ （FⅦa） and tissue factor pathway inhibitor （TFPI）/X a in patients with urticaria. Methods A total of 27 patients with chronic urticaria （CU）, 27 patients with acute urticaria （AU） and 26 normal human controls were included in this study. Symptom score was determined and disease course was surveyed in these patients. ELISA was used to detect the plasma levels of D-dimer, F VH a and （TFPI）/X a in patients and controls. The relation of clinical symptom and disease course to plasma levels of these parameters was assessed. Results In patients with AU and normal controls, the plasma level of D-dimer was 450.57 ± 242.13 ng/mL and 266.81 ± 40.68 ng/mL, respectively, the level of FⅦa, 2.23 ±0.74 ng/mL and 5.23 ± 1.35 ng/mL, respectively, and the level of TFPI/Xa 0.87 ± 0.13 nmol/L and 0.88 ± 0.12 nmol/L, respectively. There was a significant difference in the level of both D-dimer and FⅦa （both P 〈 0.01 ）, whereas no difference was observed in that of TFPI/X a （P 〉 0.05 ） between patients with AU and normal controls. In addition, increased level of D-dimer and decreased level of FⅦa were noticed in patients with CU compared with those in normal controls （593.80 ± 294.04 ng/mL vs 266.81 ± 40.68 ng/mL, 3.98 ± 0.35 ng/mL vs 5.23 ± 1.35 ng/mL, both P 〈 0.01 ）, but there was no significant difference in the plasma level of TFPI/Xa （0.87 ± 0.16 nmol/L vs 0.88 ± 0.12 nmol/L, P 〉 0.05）. Significant difference was observed in the plasma level of D-dimer and FⅦa between patients with AU and CU （450.57 ± 242.13 ng/mL vs 593.80 ± 294.04 ng/mL, P 〈 0.05; 2.23 ± 0.74 ng/mL vs 3.98 ± 0.35 ng/mL, P 〈 0.01 ）. The plasma level of D-dimer positively correlated to the symptom score of patients with CU and those with AU （r = 0.68, P 〈 0.01; r = 0.82, P 〈 0.01）,but was independent of disease course （P 〉 0.05 ）. Neither the level of FⅦa nor that of TFPI/X a correlated to symptom score or disease course of patients （all P 〉 0.05 ）. Conclusions There is an overacti, vation of coagulation cascade, consumption of blood coagulation factors and secondary fibrinolysis in patients with urticaria, suggesting that plasma D-dimer and FⅦa may be associated with the clinical symptoms of urticaria.