口服华法令抗凝中蛋白C和抗凝血酶Ⅲ的变化

Changes in Protein C and Antithrombin Ⅲ during Warfarin Anticoagulation

为探讨口服华法令抗凝中出血和血栓发生的机制，实验观察了蛋白Ｃ（ＰＣ）和抗凝血酶Ⅲ（ＡＴⅢ）在其中的变化。选择２０例风湿性心脏病择期行机械“瓣膜替换”术的患者，测定其术前、术后１４ｄ血液中ＰＣ和ＡＴⅢ的变化，与同时测定的尿纤维蛋白肽Ａ（ＦＰＡ）含量和凝血酶原时间（ＰＴ）进行比较。另选２０例换瓣３月～２年口服华法令抗凝的患者为随访组，对照组为１０例健康志愿者。实验发现风湿性心脏瓣膜病术前ＰＣ（４．２±１．２）ｇ／ｍｌ和ＡＴⅢ（１２８．１±２３．１）％均低于对照组，ＦＰＡ（７４．２±７．２）ｎｇ／ｍｇＣｒ则高于对照组，瓣膜替换术后１４ｄ，ＰＴ值均在１８～２４ｓ，ＡＴⅢ（７２．０±６．８）％和ＦＰＡ（１２．１±３．８）ｎｇ／ｍｇＣｒ较术前降低，而ＰＣ较术前无显著变化；随访组ＦＰＡ（２．１±１．１）ｎｇ／ｍｇＣｒ和ＰＣ（３．２±０．９）ｇ／ｍｌ比术后１４ｄ水平显著降低，而ＡＴⅢ却高于对照组。

The changes in protein C (PC) and antithrombin Ⅲ (ATⅢ) were observed to investigate the mechanism of bleeding and thrombogenesis during warfarin anticoagulation Twenty patients undergoing the treatment of rheumatic heart ralve disease (RHVD) with valve replacement were chosen and the levels of PC and ATⅢ in plasma, fibrimopeptide A (FPA) in urine and prothrombin time (PT) were determined at the preoperation and the 14th postoperative day Other 20 patients who had been replaced valve(s) in 3 months to 2 years served as follow up group and 10 healthy volunteers as control group PC (4 2±1 2) g/ml and ATⅢ (128 1±23 1) % was lower in non treated RHVD patients than in control group at preoperation FPA (74 2±7 2) ng/mg Cr, however, was higher, PT was asked keeping in normal range at preoperation, but in 18￣24 s after warfarin anticoagulation in postoperation At the 14th day of postoperation FPA (12 1±3 8) ng/mg Cr and ATⅢ (72 01±6 8) g/ml were significantly lower than those of preoperation, PC had no significant alteration In follow up group, FPA (2 1±1 1) ng/mg Cr and PC (3 2±0 9) g/ml were markedly declined as compared with those at the 14th postoperative day , but ATⅢ obviously higher than in control group It was concluded that the changes in PC and ATⅢ might be a reason for bleeding or thrombogensis during warfain anticoagulation