围手术期卒中患者外周血vWF及ADAMTS13检测及临床意义

Determination of VWF and ADAMTS13 in patients with perioperative stroke

目的探讨v WF(血管性血友病因子)、ADAMTS13(血管性血友病因子裂解酶)在围手术期卒中的发生发展中所起的作用。方法收集围手术期内发生缺血性卒中的患者31例做为实验组,将实验组分为腔隙性梗死组、小面积梗死组以及大面积梗死组3个亚组。同时收集48例健康体检者做为对照组。采用酶联免疫吸附法(ELISA)检测v WF抗原、ADAMTS13抗原含量,应用残余胶原结合试验检测ADAMTS13的活性。结果 (1)实验组患者血浆中v WF抗原水平明显高于对照组(P<0.05),ADAMTS13活性水平及ADAMTS13抗原含量均明显低于对照组(P<0.05)。(2)实验组3个亚组的v WF抗原水平在大面积梗死组最高,腔隙性梗死组最低,大面积梗死组与腔隙性梗死组间差异有显著性(P<0.05)。(3)ADAMTS13抗原含量在大面积梗死组最低,腔隙性梗死组最高,3组间差异均具有显著性(均P<0.05),ADAMTS13活性水平在3组间差异无显著性(均P>0.05)。结论v WF及ADAMTS13参与了围手术期卒中的发生发展,ADAMTS13水平降低及v WF水平升高可能是围手术期卒中发生的危险因素。

Objective To investigate the roles of vWF and ADAMTS13 in the development of perioperative stroke. Methods We investigated vWF and ADAMTS13 in 31 patients with perioperative stroke and 48 healthy people in this study. 31 patients were divided into three subgroups：groups of lacunar infarction, small area of infarction, and large area of infarction. Using enzyme-linked immunosorbent assay （ELISA） to detect vWF antigen, ADAMTS13 antigen content, application of residual collagen binding assay ADAMTS13 activity. Results （ 1 ） The plasma vWF antigen levels were higher in patients with perioperative stroke compared to controls（ P 〈 0.05 ） , the ADAMTS13 activity and ADAMTS13 antigen levels were lower in patients with perioperative stroke than controls （ P 〈 0.05 ）. （ 2 ） VWF antigen levels were highest in large area of infarction subgroup, and lowest in lacunar infarction subgroup. There was significant difference between the large area of infarction group and the lacunar infarction group （P 〈 0.05 ）. （3）ADAMTS13 antigen content was lowest in the large area of infarction group ,and was highest in the lacunar infarction group. The differences in ADAMTS13 antigen content among the three groups were significant （P 〈 0.05 ）. There were no significant differences among the three groups in ADAMTS13 activity levels （ P 〉 0.05 ）. Conclusion VWF and ADAMTS13 are related with the occurrence and development of perioperative stroke. High vWF and low ADAMTS13 plasma levels may be risk factors for the perioperative stroke.