血栓前体蛋白对心脏瓣膜置换术后血栓形成及抗凝监测的应用价值

Application value of thrombus precursor protein in thrombosis and anticoagulation monitoring after heart valve replacement

目的探讨血栓前体蛋白(TPP)在心脏瓣膜置换术后的血栓形成及抗凝治疗中的应用价值。方法选择心脏瓣膜置换术患者30例作为病例组,健康体检者20例作为对照组,病例组在手术前及手术后第1、3、7天,对照组在体检时,分别检测血小板5项参数,TPP、D-二聚体、凝血酶原时间(PT)、国际标准化比值(INR)和血浆纤维蛋白原(Fib),并进行统计分析。结果与对照组比较,病例组患者术前PT、INR、D-二聚体和TPP均明显升高(P<0.05,P<0.01),2组血小板5项参数无显著差异(P>0.05)。病例组患者手术后第7天与第1天比较,血小板、PT、INR、D-二聚体均明显升高(P<0.05,P<0.01);术后第7天与第3天比较,TPP明显升高(P<0.01)。INR的95% CI为1.80～2.80。结论心脏瓣膜置换术患者术后第7天有明显的血栓形成倾向,结合患者手术前后各参数的变化,建议心脏瓣膜置换术后联合检测TPP、D-二聚体、INR、血小板4项参数作为临床抗凝治疗用药的检验指标体系。

Objective To explore clinical application value of thrombus precursor protein（TPP） in patients with thrombosis and anticoagulant treatment after the heart valve replacement. Methods Case group consisted of 30 heart valve replacement patients and control group consisted of 20 healthy volunteers. Five platelet （PLT） parameters, TPP, D-dimer, prothrombin time （PT）, international normalized ratio（INR） and fibrinogen（Fib） were measured before surgery and 1,3,7 days after surgery in patients of case group and in volunteers of control group. All data were analyzed using statistical methods. Results PT, INR,D-dimer, TPP levels were significantly higher in patients with heart valve disease preoperatively than in volunteers and five platelet parameters showed no significant difference between the 2 groups. In case group, PLT, PT, INR, D-dimer were significantly higher 7 days after operation than 1 day post-operation. TPP level was significantly higher 7 days after operation than 3 days post-operation. INR 95% of confidence limit in 10 patients who had no thrombosis or bleeding was 1.80--2.80, which was appropriate INR in patients after operation. Conclusions The patients have obvious tendency towards thrombosis 7 days after heart valve replacement. It is recommended to detect four parameters including TPP, D-dimer,INR and PLT in conjunction with changes in various parameters after operation as indicator system for clinical anticoagulant treatment.