慢性阻塞性肺病患者血栓前状态与肝素治疗

Prethrombotic State in Patients with Chronic Obstructive Pulmonary Disease and Treatment with Heparin

慢性阻塞性肺病（ＣＯＰＤ）患者可并发肺血栓栓塞，为研究ＣＯＰＤ是否存在血栓前状态。检测了３７例ＣＯＰＤ患者敏感度较高的有关凝血标志物：凝血酶原片段Ｆ１＋２（Ｆ１＋２）、颗粒膜蛋白－１４０（ＧＭＰ－１４０）、血管性假血友病因子（ｖＷＦ）、纤维蛋白原（Ｆｇ）及Ｄ－二聚体（ＤＤ），并与２０例健康对照组进行比较。结果显示：ＣＯＰＤ患者Ｆ１＋２、ＧＭＰ－１４０、ｖＷＦ、Ｆｇ、ＤＤ均明显高于对照组（Ｐ＜０．０５）；１６例病情稳定，且Ｆ１＋２＞１．６５ｎｍｏｌ／Ｌ（ｘ＋２ｓ）的ＣＯＰＤ患者静注肝素治疗（１００ｍｇ／ｄ）１０天后，Ｆ１＋２、ｖＷＦ、ＧＭＰ－１４０和ＰａＣＯ２均下降（Ｐ均＜０．０５）。表明ＣＯＰＤ患者确实存在血栓前状态。肝素治疗对上述凝血系统活性与血气的影响，提示综合治疗基础上加以该治疗有助于改善ＣＯＰＤ患者的预后。

Several clinical reports have evidenced that chronic obstructive pulmonary disease (COPD) may be complicated by thrombosis in pulmonary vessels. The aim of this study was to investigate the putative prethrombotic state of COPD. Highly sensitive molecular markers of hemostasis, plasma levles of prethrombin F 1+2 fragment (F 1+2 ), granule membrane protein 140 (GMP 140), von Willebrand factor (vWF), Fibrinogen (Fg), and D dimer fragments (DD) were simultaneously measured in 37 COPD patients and in 20 controls matched for sex and age. The results showed that COPD patients had significantly higher values of F 1+2 ( P<0.001) , GMP 140( P<0.001) , vWF ( P<0.001) , Fg ( P<0.005) and DD ( P<0.001) than controls. In 16 patients with stable COPD and F 1+2 greater than 1.65 nmol/L (mean +2s of control), intra venose heparin therapy (100mg qd for 10 days) significantly reduced F 1+2 ( P<0.005) , vWF ( P<0.05) , GMP 140 ( P<0.05), and PaCO 2 ( P<0.05) . This study has confirmed that COPD patients have an ongoing prethrombotic state which potentially accounts for thrombosis occurring in pulmonary vessels. The effects of heparin on clotting system activation and blood gas indicate that such treatment may be beneficial to COPD patients.