肺栓塞患者治疗后凝血纤溶系统指标变化与血栓近期溶解的关系

Relationships between changes of coagulation-fibrinolytic system paratmeters and recent dissolution of thrombus after treatment in patients with pulmonary embolism

目的探讨肺栓塞（PE）患者治疗后14d内血浆纤维蛋白原（Fib）、D-二聚体和纤维蛋白原降解产物（FDP）的变化规律及与血栓近期溶解的关系。方法采用前瞻性研究方法，选择2015年1月至2016年3月4家医院呼吸内科收治的PE患者，入院后进行溶栓或抗凝治疗。于治疗前24h内和治疗后14d行CT肺动脉造影（CTPA），以Mastora评分计算肺动脉阻塞指数（PAOI）评估血栓负荷。治疗前及治疗后1、2、3、5、7和14d测定血浆Fib、D-二聚体和FDP水平，分析其变化规律及与PAOI的相关性。结果共纳入42例PE患者。PE患者Fib于治疗3d达峰值（g／L：4．24±1．45比3．83±1．56），随后逐渐下降，与二次方曲线模型拟合度最高，但差异均无统计学意义（P=0．095）；D-二聚体和FDP治疗后持续下降，治疗后14d达最低[D-二聚体（mg／L）：1．58±1．38比8．84±6．35，FDP（mg／L）：4．23±3．63比23．41±16．54]，与三次方曲线模型拟合度最高（F值分别为32．190和34．326，均P=0．000）。治疗前和治疗后14dPAOI变化量[（18．77±14．22）％]与Fib变化量[（1．20±0．93）g／L]无相关性（r值为-0．194，P=0．219），与D-二聚体变化量[（7．29±7．10）mg／L]和FDP变化量[（19．29±18．67）mg／L]均呈正相关（r值分别为0．556和0．460，P分别为0．020和0．002）。结论PE治疗后D-二聚体和FDP水平持续下降提示血栓溶解。

Objective To discuss the relationships between regular pattern changes of plasma fibrinogen （Fib）, D-dimer and fibrinogen degradation products （FDP） levels and the recent dissolution of thrombus in patients with pulmonary embolism （PE） in 14 days after treatment. Methods A prospective study was conducted. PE patients admitted to Departments of Respiratory Disease in 4 hospitals from January 2015 to March 2016 were enrolled and all of them were treated with thrombolysis and/or anticoagulation after admission. The computed tomographic pulmonary angiograpby （CTPA） was examined pre-treatment and 14 days post-treatment in PE patients. The pulmonary artery obstruction index （PAOI） was assessed according to the Mastora scoring method to estimate the thrombus load. The plasma Fib, D-dimer and FDP levels were measured before and on 1, 2, 3, 5, 7 and 14 days after treatment, and the relationships between the change regularities of these parameters and PAOI were also analyzed. Results A total of 42 PE patients were enrolled. The curve change of coagulation-fibrinolytic system parameters in 14 days after treatment showed that the Fib level was raised to its peak on the 3rd day after treatment and then decreased （g/L： 4.24 ± 1.45 vs. 3.83 ± 1.56）, representing that its curve change was in accordance with the quadratic model （P = 0.095）. After treatment, the D-dimer and FDP levels were kept declining, they were reached the valley on 14th day [D-dimer （mg/L）： 1.58 ± 1.38 vs. 8.84 ± 6.35, FDP （mg/L）： 4.23 ± 3.63 vs. 23.41 ± 16.54], and their curve changes were in accordance with the cubic model （F was 32.190 and 34.326, respectively both P = 0.000）. The PAOI variation before and 14 days after treatment [（18.77 ± 14.22）%] was not correlated with Fib variation [（1.20 ± 0.93） g/L, r = -0.194, P = 0.219], but was positively correlated with D-dimer variation [（7.29 ± 7.10） mg/L] and FDP variation [（19.29 ± 18.67） mg/L, r was 0.556 and 0.460, respectively; P was 0.020 and 0.002, respectively]. Conehlsions The D-dimer and FDP levels are kept falling in PE patients after treatment, suggesting that the pulmonary artery embolus is being dissolved.