凝血酶原前体蛋白在抗凝监测中的临床研究

The clinical study of prothrombin precursor protein in monitoring anticoagulation

目的探讨凝血酶原前体蛋白(PIVKA-Ⅱ)在华法林抗凝治疗监测中的意义。方法动态监测60例心脏机械瓣膜置换术后行抗凝治疗病人(实验组)的血浆PIVKA-Ⅱ浓度、凝血酶原时间(prothrombin time,PT)、国际标准化比率(international normalized ratio,INR),比较3者出现明显异常的最早时间,分析PIVKA-Ⅱ与PT及INR之间的相关性。结果实验组首次服华法林后6h,血浆PIVKA-Ⅱ浓度即出现明显异常,并随时间增加而增高;实验组首次服华法林后60h,PT出现明显异常,并随时间增加而增高;实验组首次服华法林后24h,INR出现明显异常,并随时间增加而增高;线性相关分析,结果显示PIVKA-Ⅱ浓度与PT呈正相关(r=0.786,P<0.01);PIVKA-Ⅱ浓度与INR呈正相关(r=0.737,P<0.01)。结论在抗凝治疗的患者中,通过监测患者的血浆PIVKA-Ⅱ浓度可以有效地监测其抗凝程度,联合监测患者的血浆PIVKA-Ⅱ浓度、PT、INR则更能早期、有效的监测患者抗凝程度。

Objectives To investigate the clinical significance of prothrombin precursor protein （PIVKA-Ⅱ ） in therapeutic monitoring antieoagulation of warfarin. Methods Plasma PIVKA-Ⅱ levels of 20 controls and 60 patients with prosthetic heart valve replacement after administration of warfarin were measured. Prothrombin tim （PT） and international normalized ratio （INR） were determined. The relativity with PIVKA-Ⅱ , PT and INR was compared. Results PIVKA-Ⅱ levels on the 6 hours after beginning taking warfarin were obviously increased with time increased in the therapy group; PT levels on the 60 hours after beginning taking warfarin were obviously increased with time increased in the therapy group; INR levels on the 24 hours after beginning taking warfarin were obvious increased with time increased in the therapy group; It was positive correlation between PIVKA-Ⅱ and PT （r=0.786, P 〈 0.01） ; It was also positive correlation between PIVKA-Ⅱ and INR （ r =0.737, P 〈 0.01 ）. Conclusions In clinical therapeutic monitoring anticoagulation, PIVKA-Ⅱ had high sensitivity, which could be an auxiliary reference. Jointing monitoring of the PIVKA-Ⅱ , PT and INR level could more early and effectively predict anticoagulation extent.