溶血磷脂酸对移植肾血栓形成的预警作用

Early-warning effect of plasma lysophosphatidic acid on thrombosis among renal transplantation patients

目的探讨在肾移植患者中监测血浆溶血磷脂酸(LPA)含量来判断体内凝血状态,评价血浆LPA水平对肾移植血栓性疾病早期诊断和积极预防的临床价值。方法入选患者150例,其中规律血透尿毒症患者50例(尿毒症组),肾移植患者(术后2周内)50例(肾移植组),50例健康者(对照组)。分别测定3组术后1～2周血浆中LPA水平,肾移植组术后2周内每日检测凝血功能常规、移植肾彩色多普勒及能量图(CDFI),计算部分凝血活酶时间(APTT)/凝血酶原时间(PT)值,记录移植肾主动脉、段动脉血流速度(VS)及阻力指数(RI)。结果术后1～2周,通过B超检查,肾移植组有血栓形成患者2例(血栓形成组),无血栓形成48例(无血栓形成组)。血栓形成组术后2周LPA浓度明显高于无血栓形成组(<0.01)。术后1周,无血栓形成组与尿毒症组及对照组LPA浓度差异均有统计学意义(均<0.01)。肾移植术后2周,血栓形成组与无血栓形成组肾主动脉及段动脉VS与RI差异均有统计学意义(均>0.05)。结论血浆中LPA作为体内凝血及血栓形成过程早期释放的标志物,对肾移植后移植肾血栓形成的诊断及指导合理应用抗血小板及抗凝药物有一定应用价值,可作为移植肾血栓形成的预警指标。

Objective To study the level of plasma lysophosphatidic acid（LPA） in renal transplantation patients with thrombosis,and to evaluate its clinical effects of early diagnosis and prevetion.Methods One hundred patients were equally divided into 2 groups,uremia group,renal transplantation group（two weeks after operation）and 50 healthy persons were served as the controls（control group）.LPA levels of three group were determined.Among renal transplantation group,normal coagulation function and color dopplor flow imaging（CDFI） were tested very day within 2 weeks after operation;the value of activated partial thromboplastin time（APTT）/ prothrombin time was calculated;velocity of main renal artery and segmental artery and resistance index（RI） were recorded.Results ？In renal transplantation group,1～2 weeks after operation,there were 2 patients with thrombosis,and the other 48 patients were without thrombosis.1 week after operation,there were significant differences of PLA levels among patients without thrombosis,uremia group and the control group（P0.01）.2 weeks after operation,LPA level of patients with thrombosis was significantly higher than that of patients without thrombosis（P0.01）;there were no significant differences in velocity of main renal artery and segmental artery and RI among the patients with or without thrombosis（P0.05）.Conclusions As a molecular marker released by activated platelet in vivo,Plasma LPA may be valuable for diagnosis of thrombosis after renal transplantation and guiding the treatment and can be considered as a early-warning index.