血浆血栓前状态分子标志物水平变化在围手术期血栓形成早期诊断中的应用

APPLICATION OF PLASMA PRETHROMBOTIC STATE MOLECULAR MARKER IN EARLY DIAGNOSE OF THROMBOSIS DURING PERIOPERATION

目的了解动态监测血浆血栓前状态分子标志物水平在围手术期血栓形成早期诊断中的应用价值。方法选择40例妇科、泌尿外科恶性肿瘤（未转移）、20例良性和非肿瘤手术患者及20例健康体检者。分别于术前、术后6 h3、d和7 d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（D-dimer,D-D）、血栓前体蛋白（thrombus precursor protein,TpP）、凝血酶抗凝血酶复合物（thrombin-antithrombin complexes,TAT）、组织因子（tissue factor,TF）、P选择素（P-Selectin,P-S）、组织因子途径抑制物（tissue factor pass inhibitory,TFPI）、纤溶酶原激活物抑制物1（plasminogen activator inhibitory-1,PAI-1）的水平。结果恶性肿瘤患者血浆TF、TpP和D-D水平在术后6 h3、d持续升高达峰值,TF、D-D术后7 d仍高于术前,TpP基本恢复到术前水平。P-S、TAT水平术后6 h已升到最高值,P-S术后3 d仍偏高,7 d基本恢复到术前水平。TAT术后3 d已下降到术前水平。TFPI、PAI-1术后6 h降低,3 d开始升高,之后TFPI维持在接近术前水平,PAI-1偏高,到第7 d才降到术前水平。良性病变患者除TF、PAI-1术后6 h高于术前,其它无明显变化。结论妇科、泌尿外科恶性肿瘤患者血浆血栓前状态标志物P-S、TpP和TF、D-D水平在围手术期的第1-3 d和第1-7 d分别明显高于术前;良性病变组术后6 d TF、PAI-1高于术前,表明此时机体处于血栓前状态或容易形成血栓,恶性肿瘤组术后6 h同时有PAI-1下降、D-D升高的原、继发性纤溶亢进存在,所以临床采取早期干预措施时应全面考虑。

Objective To measure the value of plasma prethrombotic state molecular marker in early diagnosis of thrombosis in perioperation. Methods Gynecological and urological malignant tumor（not transfer） patients （n=50）, benign or not tumor patients （n=20） and normal individuals （ n =20）. At pre-operation,post-operation 6 h,3 d and 7 d detect the leave of plasm prethrombotie state molecular marker tissue factor（TF）, tissue factor pass inhibitory（TFPI）, thrombus precursor protein （TpP）, plasminogen activator inhibitory-1 （PAI-1）, P-Selectin （P-S）, Thrombin - Antithrombin complexes （TAT）, D-dimer （D-D） with ELISA, transmission immunity nephelometer. Results Malignant tumor patients,the levels of plasma TF,TpP,D-D in 6 h and 3 d of post-operation rose to peak value. In 7 d of post-operation the levels of TF, D-D were still higher than those of pre-operation. TpP return to pre-operation. The levels of P-S, TAT in post-operation 6 h rose to maximum,the P-S in post-operation 3 d was still on a high level. It returned to pre-operation level by 7 d after operation. The level of TAT fell to pre-operation in post-operation 3 d. TFPI and PAI-1 level in post-operation 6 h decreased, at 3 d begin rise. Higher TFPI keep near pre-operation, the levels of PAId on the high side. Till in post-operation 7 d fall to pre-operation. In benign or not tumor patients,the levels of plasm TF,PAI-1 in post-operation 6 h were higher than pre-operation, other markers had not significant change. Conclusion In gynecological malignant patients and urological malignant tumor（not transfer） patients, the levels of plasma prethrombotic state molecular marker P-S, TpP and TF, D-D in post-operation 1-3 d