血栓前状态分子标志物在手术患者围术期的动态变化及其临床意义

Dynamic Change of Plasma Prethrombotic State Molecular Mar-ker Levels in Perioperative Period of Patients and Its Clinical Significance

本研究旨在观察手术患者围术期血浆血栓前状态分子标志物的动态变化,为临床判断血栓前状态、对高危患者采取早期干预措施提供实验依据。选择40例妇科、泌尿科恶性肿瘤(未转移)、20例良性肿瘤和非肿瘤手术患者及20例健康体检者纳入分析。于术前、术后6小时、3天、7天分别用ELISA、透射免疫比浊法检测其血浆血栓前状态分子标志物D-二聚体、血栓前体蛋白(TpP)、凝血酶抗凝血酶复合物(TAT)、组织因子(TF)、P选择素(P-S)、组织途径抑制物(TFPI)、纤溶酶原激活物抑制物1(PAI-1)的水平。结果表明:恶性肿瘤患者术后6小时,血浆TF、TpP、D-D、P-S、TAT水平高于术前,TFPI、PAI-1水平降低,差异有显著性意义;术后3天TF、TpP、D-D持续升高,PAI-1开始升高,与术前比较差异显著,P-S、TAT有所下降但仍高于术前;术后7天TpP、TAT、P-S、TFPI、PAI-1基本恢复到术前水平,TF、D-D与术前比较差异还有显著性意义。良性疾病、非肿瘤手术患者除TF、PAI-1术后6小时高于术前外,上述标志物术后各时间点与术前比较差异不显著。结论:妇科、泌尿科肿瘤患者围术期血浆血栓前状态分子标志物在术后6小时处于凝血与纤溶激活的高水平;术后3天以高凝状态为主,术后7天上述标志物基本恢复到术前水平。良性疾病患者术后6小时分子标志物处于轻度高凝状态。

This study was aimed to investigate the dynamic changes of plasma prethrombotic state molecular marker levels during perioperation of patients and to provide laboratorial evidence for clinical diagnosis of these patients so as to take intervenient measure to high risk patients. 40 patients with gynecological and urological malignant tumors （without metastasis） and 20 patients with benign tumors and 20 healthy individuals were selected for analysis. The levels of plasm prethrombotic state molecular markers including TF,TFP1, TpP, PAI-1 ,P-S,TAT and D-D were measured by using ELISA method and transmission immunity nephelometry. The results showed that the levels of TF,TpP,D-D,P-S and TAT in plasma of patients with malignant tumors at 6 hours after operation were higher than that before operation, but the levels of TFPI and PAI-1 in these patients after operation were lower than before operation, and there was significant difference as compared with the levels of these markers before operation. At day 3 after operation, the levels of TF,TpP and D-D continuously increased; the level of PAI-1 begins to elevate, there were significant difference in comparison with that before operation ; the levels of P-S and TAT decreased, but still were higher than that before operation. At day 7 after operation, the levels of TpP,TAT ,P-S ,TFPI and PAI-1 returned to levels before operation, but the levels of TF and D-D were still higher than that before operation, and showed significant difference from that before operation. In patients with benign tumors and non- operation patients, the levels of prethrombotic state molecular markers mentioned above at different points of time after operation did not present difference, except levels of TF and D-D that at 6 hours after operation were higher than that before operation. It is concluded that at 6 hours after operation of patients with gynecological and urological malignant tumours, the plasma levels of prethrombotic state molecular markers are in higher state of coagulation and fibrinolysis, at 3 days after operation these levels are mainly in coagulation state. At 7 days after operation, the level of these markers returned to levels before operation. At 6 hours after operation the levels of these markers in patients with benign tumors are in mild coagulation state.