血管性血友病因子在静脉血栓栓塞症中的作用

Effect of blood vessel endothelium dysfunction in patients with venous thromboembolism

目的观察静脉血栓栓塞症(venous thromboembolism,VTE)患者内皮功能障碍标志物的变化,探讨内皮功能障碍导致机体凝血-抗凝血制约关系的失衡在VTE发生发展中的作用。方法选取120例确诊的VTE患者和50例健康人为研究对象,其中深静脉血栓形成(deep venous thrombosis,DVT)患者84例,DVT合并肺血栓栓塞症(pulmonary thromboembolism,PTE)患者36例,采用SYSMEX CA-7000型血液凝固仪免疫法测定血管性血友病因子(von Willebrand Factor,vWF)和D-二聚体(D-dimer)水平;发色底物法测定抗凝血酶活性(antithrombin,AT)、蛋白C活性(protein C,PC)、纤溶酶原激活物抑制因子1(plasminogen activator inhibitor-1,PAI-1)和组织型纤溶酶原激活物(tissue plasminogen activator,t-PA);凝固法测定凝血因子Ⅴ活性(factorⅤ,FⅤ)和凝血因子Ⅷ活性(factorⅧ,FⅧ)。结果VTE患者vWF、PAI-1、D-dimer水平高于对照组,vWF(184.64±27.21)%vs(97.95±15.89)%(P<0.01),PAI-1(2.61±0.79)AU/ml vs(0.55±0.28)AU/ml(P<0.01),D-dimer(2 501.95±942.91)μg/L vs(204.43±51.24)μg/L(P<0.01);AT、PCt、-PA水平低于对照组,AT(70.03±13.76)%vs(99.57±12.36)%(P<0.01),PC(72.76±18.51)%vs(117.64±24.38)%(P<0.01),t-PA(0.23±0.04)U/ml vs(0.41±0.07)U/ml(P<0.01);FⅤ(97.28±17.13)%vs(96.45±16.04)%(P>0.05)、FⅧ(101.00±17.57)%vs(100.48±17.38)%(P>0.05)。DVT组与DVT合并PTE组比较vWF、FⅧ、AT差异有统计学意义,vWF(173.90±25.03)%vs(189.23±26.94)%(P<0.01),FⅧ(95.12±16.02)%vs(102.78±17.53)%(P<0.05),AT(72.65±13.55)%vs(63.92±12.39)%(P<0.01);而FⅤ、PC、PAI-1、t-PA、D-dimer差异无统计学意义,FⅤ(94.73±18.89)%vs(98.37±16.32)%(P>0.05),PC(74.03±18.83)%vs(69.79±17.61)%(P>0.05);PAI-1(2.56±0.28)AU/ml vs(2.62±0.78)AU/ml(P>0.05),t-PA(0.23±0.04)U/ml vs(0.23±0.03)U/ml(P>0.05),D-dimer(2 458.5±809.31)μg/L vs(2 603.2±1 206.04)μg/L(P>0.05)。结论内皮系统的损伤是VTE的临床特征之一,内皮功能障碍在VTE发生发展中起重要作用。

Objective To investigate the endothelial dysfunction in venous thromboembolism （VTE）. The relationship was observed between the levels of the parameters and development of VTE. Methods 120 VTE patients and 50 normal controls were involved,further more,the VTE patients included 84 deep venous thrombosis（DVT） and 36 DVT associated PTE. The plasma level of yon Willebrand Factor（vWF） ,activity of factor V （FV） ,activity of factor Ⅷ （FⅧ）, antithrombase activity （ AT）, protein C activity （PC）, plasminogen activator inhibitor type-1 （PALl）, tissueplasminogen activator（t PA）, D-dimer were detected by SYSMEX CA-7000 blood coagulation instrument. Results The levels of vWF,PAI-1,D-dimer were distinguished higher in VTE patients than those of control group, vWF（184.64 ± 27.21）%0 vs （97.95±15.89）%（P 〈0.01）;PAI-1（2.61±0.79） AU/ml vs （0.55±0.28） AU/ml（P 〈C0.01）; D-dimer（2 501.95± 942.91）μg/L vs （ 204. 43 ± 51. 24 ）μg/L（P 〈0.01）,and AT, PC and t PA always were significantly lower than those of the control group, AT（70.03± 13.76） % vs （99.57± 12.36） % （ P 〈0.01） ;PC（72.76± 18. S1）% vs （117.64±24.38）%（P 〈0.01）;t-PA（0.23±0.04） U/ml vs （0.41±0.07） U/mI（P 〈0.01）. FV （97. 28±17.13） % vs （96.45±16.04）%（P）0.05）;FⅧ（101.00±17.57）% vs （100.48±17.38）%（P〉0.05）.In comparison between the patients of DVT and the patients of DVT associated PTE, vWF, FⅧ and AT were all statistically different,vWF（173. 90±25. 03） % vs （189.23±26.94） % （ P 〈C0.01） ;FⅧ （95.12± 16.02） % vs （102.78± 17.53）%（P〈0.05）;AT（72.65±13.55）% vs （63.92±12.39）%（P 〈0. 01）. Meanwhile,FV,PC,PAI-1,t-PA, D-dimer were also no statistical differences,FV （94.73±18.89）% vs （98.37±16.32）%（P 2〉0.05）;PC（74.03±18.83）% vs （69.79±17.61）%（ P〉0.05）;PAI-1（2.56±0.28） AU/ml vs （2.62±0.78） AU/ml（ P 〉0.05）;t-PA （0. 23±0. 04） U/mlvs （0.23±0.03） U/ml（ P〉0.05）;D-dimer（2 458. 5 ± 809. 31）μg/L vs（2 603.2±1 206.04）μg/L（ P 〉0.05）. Conclusion Endothelium injury is not only one of the clinical features in VTE, but also plays an important part in the development of VTE.