心肺复苏后组织因子和组织因子途径抑制物的动态变化和临床意义

The dynamic changes and clinical significance of tissue factor and tissue factor pathway inhibitor after cardiopulmonary resuscitation

目的观察院内心肺复苏后不同时问点组织因子（TF）和组织因子途径抑制物（TFPI）水平的动态变化特点并探讨其临床意义。方法选择2005年9月至2007年9月温州医学院附属第一医院急诊科收治的年龄〉16岁明确心搏停止时间的心肺复苏患者24例，依据是否达到自主循环恢复标准随机分为ROSC和未ROSC两组，分别记录不问患者心搏停止的病因和临床特点，并用ELISA方法检测心肺复苏（CPR）后30min，60min，6h，24h，48h血清TF和TFP1抗原浓度，10例来自健康体检的健康自愿者为对照组。计量数据用均数±标准差（x±s）来表示，两组计量数据的比较采用独立样本t检验，三组及以上计量数据比较采用单因素方差分析法，计数数据的比较采用四格表精确y。检验，以P〈0．05为差异具有统计学意义。结果与对照组比较，ROSC组患者在CPR30min血TF水平显著升高（P〈0．01），在CPR6h达高峰，在CPR48h时已下降；与对照组及ROSC组同时间点比较，未ROSC组血TF水平更是显著升高（P〈0．01）。与对照组比较，在CPR后30min，ROSC和未ROSC两组血清TFPI水平差异无统计学意义（P〉0．05），60min后ROSC组血清TFPI水平逐渐升高并有显著差别（P〈0．01或〈0．05）。与对照组比较，未ROSC组和ROSC组患者在CPR30min时的TF/TFPI水平均显著性升高（P〈0．01），且前者显著高于后者（P〈0．01），在ROSC组，TF/TFPI值在CPR后6h有显著升高（P〈0．01），在48h下降。结论血清TF和TFPI水平在院内心肺复苏的患者中明显升高，CPR后半小时的TF和TF/TFPI的水平可用于判断预后。

Objective To investigate the changes of tissue factor（TF） and tissue factor pathway inhibitor （TFPI） at different time points after in-hospital cardiopulmonary resuscitation （CPR）, and to explore the role of TF and TFPI in CPR. Method From September 2005 to September 2007,24 patients, who suffered from cardiac arrest,were selected from the of emergency medicine department, The First Affiliated Hospital, Wenzhou Medical College. The selected patients were older than 16 years old and had identified cardiac arrest time. All patients were randomly classified into two groups： those who had return of spontaneous circulation （ROSC） （n = 12） and those without ROSC （ n = 12）. Ten normal healthy volunteers served as control subjects （ n = 10）. Etiology of the cardiac arrest and clinical characlerislics during cardiopulmonary resuscitation were enregistered. Serial levels of TF and TFPI at different time points of 30 min, 60 min, 6 h, 24 h, 48 h after CPR were measured by enzyme linked immunosorbent assay （ELISA） after cardiac arrest and CPR. Data were expressed as mean ± standard deviation, two- tailed t test and ANOVA and four flod table chi-square test were used for comparison in SPSS 11.5 software, and changes were considered as statistically significant if P value was less than 0.05. Results In patients with ROSC,TF obviously increased at 30 min after CPR, reached peak at 6 h. TF levels in patients without ROSC were higher compared to those of the control group and ROSC at the same time point. The levels of TFPI had no significantly differentce at 50 min after CPR, and TFPI, obviously elevated at 60 min after CPR in ROSC group compared to those of the control group and without-ROSC group. In comparison with contM group, the ratio of TF/TFPI at 30 min after CPR in without-ROSC group and ROSC group were marked elevated. The ratio of TF/TFPI in without- ROSC group showed marked elevations compared to that of ROSC group. In ROSC group, the ratio of TF/TFPI peaked at 6 h after CPR and descended at 48 h after CPR. Conclusions The TF and TFPI levels after CPR ia patients with in-hospital cardiac obviously increase. The levels of TF and TF/TFPI at 30 rain after CPR can be used for predicting the prognosis of patients with in-hospital cardiac arrest.