抗心磷脂抗体、蛋白C与肝硬化门静脉血栓的关系

The association of anticardiolipin antibody and protein C with portal vein thrombosis

目的研究肝硬化门静脉血栓（PVT）患者抗心磷脂抗体（ACA）和蛋白C（PC）的变化。方法收集2006年1月至2007年12月肝硬化PVT患者20例作为血栓组，肝硬化非血栓患者40例作为对照组，对两组凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fib）、ACA和PC进行检测，对比血栓组和对照组各项指标的差异。根据两组患者肝功能Child—Pugh分级，比较各级别上述各指标差异。结果血栓组ACA阳性患者7例（35％），对照组4例（10％，P=0．045）。血栓组ACA-IgG为（10．15±5．31）U／ml、PC为（2．47±0．62）mg／L，对照组分别为（6．70±3．75）U／ml和（2．93±0．88）mg／L，两组比较差异有统计学意义（P〈0．05）；而两组的PT、APTT、Fib和ACA—IgM结果相似（P〉0．05）。PT、APTT、Fib和PC在Child—Pugh各级间比较差异均有统计学意义（P值均〈0．05）；ACA—IgG和ACA—IgM随肝功能恶化而升高，但各级间比较差异均无统计学意义（P值均〉0．05）。血栓组ACA阳性率为35％（7／20），而对照组ACA阳性率为10％（4／40），两组比较差异有统计学意义（P=0．045）。结论肝硬化患者凝血和抗凝系统存在明显异常。肝硬化PVT患者与无PVT患者相比，ACA—IgG明显升高而PC则明显降低，ACA—IgG和PC在肝硬化PVT形成中可能起有重要作用。

Objective To investigate the changes of anticardiolipin antibody（ACA） and protein C（PC） in cirrhotic patients with or without portal vein thrombosis（PVT）. Methods During Jan. 2006 to Dec. 2007, 60 cirrhotic patients with （n=20） or without （n=40） PVT were analyzed. The concentrations of prothrombin time （PT）, activited patial thromboplastin time （APTT）, fibrogen, ACA and protein C （PC） were determined. Results The positive rate of ACA was 35% （7/20） in PVT group and 10% （4/40） in control group （P=0. 045）. The average level of ACA-IgG was significantly higher in PVT group [（10.15±5.31）U/ml] than that in control group [（6.70±3.75） U/ml. The concentration of PC was significantly lower in PVT group [（2.47±0.62） mg/L] than that in control group [（2.93±0.88 ）mg/L]. No difference was found in APTT, levels of fibrogen and ACA-IgM between two groups. PT and APTT were progressively prolonged and fibrogen and PC were decreasing with the severity of Child-Pugh, respectively. The levels of ACA-IgG and ACA-IgM were increasing with the severity of Child-Pugh. Conclusions The coagulation and anticoagulation system is abnormal in patients with PVT who has higer ACA IgG level and lower PC level. It is indicated that the ACA and PC may play an important role in formation of PVT.