前列腺增生患者PKRP围手术期血栓前状态的研究

State of prethrombosis in the peri-operative period of PKRP

目的探讨前列腺增生(BPH)患者经尿道等离子体双极电切术(PKRP)围手术期血小板、凝血系统、纤溶系统和下肢深静脉血流速度的变化及其在围手术期血栓前状态中的诊断意义。方法选取我院行PKRP的BPH患者50例作为研究对象(PKRP组),同期入院非手术治疗男性患者50例作为对照组,应用全自动血液黏度动态分析仪、酶联免疫吸附方法和发色底物法测定患者血小板计数(Plt)、血小板聚集指数(PAg)、血小板黏附指数(PAd)、血管性血友病因子(vWF)、凝血酶原片段1+2(F1+2)、凝血酶-抗凝血酶复合物(TAT)、纤维蛋白原(Fbg)、抗凝血酶-Ⅲ(AT-Ⅲ)、蛋白C(PC)、组织型纤溶酶原激活物(t-PA)、纤溶酶原激活剂抑制物(PAI-1)、D-二聚体(D-D);同时用彩色多普勒超声检测患者下肢深静脉(腘静脉、股静脉)的血流速度(Vpop、Vfem)。结果 BPH患者术后Pag、PAd、vWF、F1+2、TAT、D-D升高,AT-Ⅲ、PC降低,Plt、Fbg、PAI-1先降低后升高,t-PA先升高后降低,差异均有统计学意义(P<0.05);术后Vpop、Vfem降低,差异具有统计学意义(P<0.05)。结论 BPH患者PKRP围手术期血小板黏附、聚集功能增强,凝血功能增强,抗凝及纤溶功能减弱,下肢血流速度减慢,处于明显的血栓前状态。

Objective To explore the diagnostic values and relationships of platelet,coagulation,fibrinolytic function and velocity of blood stream in the lower limb deep veins in the state of prethrombosis of benign prostatic hyperplasia（BPH）patients with plasmakinetic resection of the prostate（PKRP）.Methods 50 BPH patients undergoing PKRP（PKRP group）and 50 non-operative patients（Control group）were enrolled in the study.The plasma platelet（Plt）counting,platelet aggregation index（PAg）,platelet adhesion index（PAd）,Von Willebrand factor（vWF）,prothrombin fragment 1＋2（F1＋2）,thrombin-antithrombin complex（TAT）,fibrogen（Fbg）,antithrombin-III（AT-III）,protein C（PC）,tissue-type plasminogen activator（t-PA）,plasminogen activator inhibitor-1（PAI-1）,and D-Dimer（DD）were measured by automatic blood viscosity dynamic analyzer,ELISA or colorimetric methods.Also,velocity of the blood stream in the lower limb deep veins,popliteal vein（Vpop）and femoral vein（Vfem）were measured by color doppler ultrasound.Results In the PKRP group,the Pag,Pad,vWF,F1＋2,TAT,D-D were significantly higher,while AT-Ⅲ and PC were reduced.Plt,Fbg and PAI-1 were decreased at the beginning but increased later,while the trend of t-PA was just the opposite after the operation.Statistical significances were found（P〈0.05）.There was a significant decrease of Vpop and Vfem after the operation compared with those before the operation and the control group（P〈0.05）.Conclusions Because the Plt aggregation/adhesion,coagulation system is strengthened,the anticoagulation/fibrinolytic system is weakened,and the velocity of the blood stream in the lower limb deep veins slows down.Prethrombosis is considerable in BPH patients with PKRP.