口服华法令抗凝治疗中凝血功能的变化

Variation of coagulation system in the different periods of oral warfarm anticoagulation

目的 :观察口服华法令抗凝 (OWAT)不同阶段凝血状态的改变 ,尤其注意uFPA在判断OWAT效果中的价值。方法 :换瓣术后 14d(换瓣 14d组 )和术后 0 .5～ 2年 (术后随访组 )病人各 2 0例 ,要求INR(国际正常比值 )值在 1.8～ 2 .8,正常组为 10例健康志愿者。取静脉血 7ml,留尿液 5ml,测定蛋白C(PC)、6 酮 前列腺 1α(6 K F1α)、血小斑颗粒膜蛋白 140 (GMP 140 )和D 二聚体 (D 2 Dimer)及抗凝血酶Ⅲ (ATⅢ )、组织型纤溶酶激活物 (t PA)和尿液纤维蛋白肽A(FPA)。结果 :换瓣 14d组uFPA显著低于正常正常组 ,D2D却显著高于正常组。术后随访组病人的uFPA比术后 14d更低 ,且与PT相关性好、其值稳定于较小的变化范围 (1.0～ 3.2 μg·g- 1Cr) ;D2D比换瓣 14d组有所降低 ,但二者无显著差异。ATⅢ在换瓣 14d组低于正常组 ,但在术后随访组却显著高于正常组 ;PC在换瓣 14d组低于正常组 ,在术后随访组却进一步降低 ;t PA和 6 K F1α在OWAT期间高于正常组 ,换瓣 14d组和随访之间无差异。结论 :OWAT早期凝血系统的变化十分复杂 ,分析其并发症原因应考虑机体凝血系统包括纤溶等的整体状态 ;以 μFPA判断OWAT中病人凝血过程的激活水平比PT更为准确、敏感 ,在纤溶系统相对稳定的情况下 ,能判断OWAT的整体抗凝效果。

AIM: To observe the coagulation state in different periods of oral warfarin anticoagulation (OWAT), and to estimate the role of uFPA in evaluating OWAT effect. METHODS: Initial group (n=20) and follow-up group (n=20) were the patients respectively at 14 days and 0.5 to 20 years after heart valve replacement with a range of INR 1.8- 2.8. Ten healthy volunteers were regarded as control group. The blood and urine samples were taken and measured. The contents of protein C (PC), platelet granulate membrane protein 140 (GMP140),6-keto-PGF1α(6-K-F1α) and D-2-Dimer (D2D), the activity of antithrombin Ⅲ (ATⅢ), and tissue-plasminogen activator (t-PA) urine fibrinopeptide A (uFPA) were measured. RESULTS: Coagulation process was inhibited during OWAT as well as fibrinolysis process activited at some extent. At the same levels of INR, coagulation process during OWAT was inhibited at a more low and steady level in the follow-up group than in the initial group. CONCLUSION: The variation of coagulation system is complex and fibrinolysis should be considered in analyising the OWAT complications, and uFPA is more accurate and senstive than INR to judge the activited levels of coagulation process during OWAT. If the fibrinolysis is relatively steady, it can reflect the whole anticoagulation effects of OWAT.