肝肺综合征大鼠D-二聚体、凝血酶原时间、纤维蛋白原、CD4、CD8的测定及意义

Hepatopulmonary syndrome-related changes in D-dimer, prothrombin time, fibrinogen, CD4 and CDs in a rat model system

目的通过对比分析肝肺综合征（HPS）模型大鼠和肝硬化组大鼠动脉血D-二聚体、凝血酶原时间（PT）、纤维蛋白原（Fib）、CD4及CD8水平与肺组织病理学变化，探明其检测的意义。方法雄眭Sprague—DawIey大鼠40只，均分为肝硬化组和HPS组，检测血气分析、动脉血D-二聚体、PT、Fib、CD4、CD8，光镜观察肺组织病理变化。结果血气分析提示：HPS组PaO，为（58．20±3．19）mmHg低于肝硬化组的（85．00±2．53）mmHg，差异有统计学意义（P〈0．001）。HPS组的D-二聚体为（0．39±0．09）mg／ml、Fib为（1．77±0．10）g／L、CD。为（32．32±4．45）／mm3分别高于肝硬化组的（0．25±0．05）mg／ml、（1．49±0．09）g／L、（20．13±6．09）／mm3，差异均有统计学意义垆值均〈0．05）；HPS组的PT为（14．86±1．04）s、CD4为（20．45±3．86）／mm3、CD4／CD8为0．64±0．09分别低于肝硬化组的（16．23±0．75）S、（26．75±5．32）／mm3和1．32±0．13，差异均有统计学意义（尸值均〈0．05）。肺组织病理结果显示，与肝硬化组比较，HPS组大鼠肺小血管内微血栓形成。结论HPS大鼠D-二聚体、PT、Fib、CD4、CD8、CD4／CD8的表达异常，可能增加肝肺综合征肺血栓栓塞发生的风险。

Objective To determine the changes in levels of D-dimer, prothrombin time （PT）, fibrinogen （Fib）, CD4 and CDs in relation to hepatopulmonary syndrome （HPS） by using a rat model system and to assess the association with pathologic changes in lung. Methods Forty male Sprague-Dawley rats were divided into equal groups for modeling of cirrhosis and HPS. The two groups were assessed by blood gas analysis, standard biochemical tests to measure D-dimer, PT, Fib, CD4 and CD8, and pathological examination of lung tissues. Results The HPS rats showed significantly lower PaO2 than the cirrhosis rats （58.20±3.19 mmHg vs. 85.00±2.53 mmHg, P = 0.000）. The HPS rats showed significantly higher levels of D-dimer, Fib and CDs than the cirrhosis rats （0.39±0.09 mg/ml vs. 0.25±0.05 mg/ml, P = 0.000; 1.77±0.10 g/L vs. and 1.49±0.09 g/L, P = 0.010; 32.32±4.45/mm3 vs. 20.13±6.09/mm3, P = 0.014）. The HPS rats showed significantly lower levels ofPT, CD4 and CD4/CD8 than the cirrhosis rats 04.86±1.04 s vs. 16.23±0.75 s, P - 0.036; 20.45±3.86/mm3 vs. 26.75±5.32/mm3, P = 0.000; 0.64±0.09 vs. 1.32±0.13, P = 0.000）. The lung tissues of the HPS rats showed microthrombosis in pulmonary vessels, which were not observed in lung tissues of the cirrhosis rats. Conclusion HPS-related differential levels of D-dimer, PT, Fib, CD4, CD8 and CD4/CDs may represent a biomarker profile suggestive of incidence of thromboembolism in lung.