肝硬化患者血栓前状态分子标志物对门静脉血栓形成的监测意义

Significance of molecular markers of prethrombotic state in monitoring portal vein thrombosis in patients with liver cirrhosis

目的探讨肝硬化患者及肝硬化合并门静脉血栓患者血栓前状态分子标志物的变化。方法将32例河南省濮阳市油田总医院2011年-2013年住院的肝硬化合并门静脉血栓的患者设为血栓组(PVT组),40例肝硬化非门静脉血栓的患者设为非血栓组(非PVT组),采用ELISA法检测血小板颗粒膜蛋白-140(GMP-140)、血管性假性血友病因子(v WF:Ag)、血栓调节蛋白(TM)、D二聚体(DD)的含量并进行分析。计量资料组间比较采用t检验。结果 PVT组GMP-140、TM、v WF:Ag、DD含量分别为(20.68±1.49)μg/L、(47.24±1.36)μg/L、(194.32±7.68)%、(0.86±0.12)mg/L,均明显高于非PVT组(13.05±0.97)μg/L、(34.05±5.03)μg/L、(136.21±3.68)%、(0.42±0.08)mg/L,两组比较差异均有统计学意义(P值均<0.01),PVT组伴中重度食管静脉曲张患者血浆GMP-140、TM、v WF:Ag、DD水平分别为(19.68±1.29)μg/L、(45.24±1.26)μg/L、(196.32±6.68)%、(0.79±0.12)mg/L,显著高于轻度食管静脉曲张患者(12.05±1.07)μg/L、(35.05±4.83)μg/L、(141.21±3.45)%、(0.36±0.08)mg/L,差异均有统计学意义(P值均<0.01);PVT组伴消化道出血患者血浆GMP-140、TM、v WF:Ag、DD水平分别为(18.98±1.18)μg/L、(46.78±1.35)μg/L、(197.32±6.39)%、(0.81±0.14)mg/L显著高于无出血患者(11.98±1.12)μg/L、(36.02±4.78)μg/L、(138.21±4.12)%、(0.35±0.12)mg/L,差异均有统计学意义(P值均<0.01)。结论血栓前状态分子标志物水平可能对肝硬化门静脉血栓形成有监测作用。

Objective To investigate the levels of molecular markers of prethrombotic state in liver cirrhosis（ LC） patients with portal vein thrombosis（ PVT） and their significance. Methods Seventy- two LC patients who were admitted to our hospital from 2011 to 2013 were selected for analysis. Among the patients,thirty- two were diagnosed with PVT by computed tomography. The plasma levels of granular membrane protein- 140（ GMP- 140）,von Willebrand Factor antigen（ v WF： Ag）,thrombomodulin（ TM）,and D- dimer（ DD） were measured by enzyme- linked immunosorbent assay. The data were analyzed using SPSS 11. 0. Continuous data were expressed as mean ±standard deviation and compared between the two groups by independent- samples t test. Results The concentrations of GMP- 140,TM,v WF： Ag,and DD in patients with PVT were significantly higher than those in patients without PVT（ 20. 68 ± 1. 49 vs 13. 05 ± 0. 97 μg / L,P 〈 0. 05; 47. 24 ± 1. 36 vs 34. 05 ± 5. 03 μg / L,P 〈 0. 05; 194. 32% ± 7. 68% vs 136. 21% ± 3. 68%,P 〈 0. 05; 0. 86 ± 0. 12 vs 0. 42 ±0. 08 mg / L,P 〈 0. 05）. The plasma levels of GMP- 140,TM,v WF： Ag,and DD in PVT patients with severe esophageal varices were significantly higher than those in patients with mild esophageal varices（ 19. 68 ± 1. 29 vs 12. 05 ± 1. 07 μg / L,P 〈 0. 05; 45. 24 ± 1. 26 vs35. 05 ± 4. 83 μg / L,P 〈 0. 05; 196. 32% ± 6. 68% vs 141. 21% ± 3. 45 %,P 〈 0. 05; 0. 79 ± 0. 12 vs 0. 36 ± 0. 08 mg / L,P 〈 0. 05）.The plasma levels of GMP- 140,TM,v WF： Ag,and DD in PVT patients with gastrointestinal bleeding were significantly higher than those in patients without gastrointestinal bleeding（ 18. 98 ± 1. 18 vs 11. 98 ± 1. 12 μg / L,P 〈 0. 01; 46. 78 ± 1. 35 vs 36. 02 ± 4. 78 μg / L,P 〈0. 01; 197. 32% ± 6. 39% vs 138. 21% ± 4. 12 %,P 〈 0. 01; 0. 81 ± 0. 14 vs 0. 35 ± 0. 12 mg / L,P 〈 0. 01）. Conclusion The levels of molecular markers of prethrombotic state can be used to monitor PVT in LC patients.