心脏瓣膜置换术后检测sEPCR的临床价值分析

Clinical Analysis of Human Soluble Endothelial Protein C Receptor after Heart Valve Replacement

目的分析血浆可溶性内皮细胞蛋白C受体(sEPCR)对心脏瓣膜置换术后抗凝治疗及检测的临床价值。方法收集2005年1月~2016年6月于南通大学第二附属医院开展心脏瓣膜置换术的78例患者为研究对象,将其分为栓塞组(38例)和对照组(40例),两组均于术前1天、术后监测INR稳定后检测INR和sEPCR,两组间INR和sEPCR值的比较分析采用t检验。结果两组间术前1天及术后INR(术前:1.24±0.32 vs 1.23±0.19;术后:1.86±0.95 vs 1.93±0.97)的差异均无统计学意义(术前t=0.17,P=0.868;术后:t=0.32,P=0.748);sEPCR术前(34.91±9.14μg/L vs 35.56±10.22μg/L)差异均无统计学意义(t=0.30,P=0.768)。栓塞组栓塞时sEPCR(101.33±27.15μg/L)显著高于对照组(41.67±11.82μg/L)(t=12.69,P=0.000)。结论栓塞组sEPCR显著高于对照组,对其进行检测可以有效地指导临床开展抗凝治疗。

Objective To investigate the clinical value of human soluble endothelial protein C receptor （sEPCR） after heart valve replacement. Methods 78 cases of patients with heart valve replacement in the Second Affiliated Hospital of Nantong University from January 2005 to June 2016 were selected as the research objects,who were divided into embolic group and control group,38 cases in embolic group and 40 cases in control group,the index of two groups 1 d preoperative, while dynamic monitoring international standardization ratio （INR） and embolism, were detected,of which INR and sEPCR were examined. The INR and sEPCR oftwo groups was compared with t test. Results The INR and sEPCR of two groups 1d preoperative had no significant difference （1. 24±0.32 vs 1. 23±0.19,34. 91±9.14 μg/L vs 35.56±10.22 μg/L;t=0. 17,P = 0. 868;t= 0.30, P = 0. 768, respectively）. The average value of dynamic monitoring INR in control group had no significant difference when compared with the results of embolism （1. 86±0.95 vs 1. 93±0.97,t=0.32,P=0. 748）. But the sEPCR had significant difference （101.33±27.15μg/L vs 41.67±11.82 μg/L,t=12.69,P=0. 000）. Conclusion The important indexes of sEPCR could effectively guide the anticoagulant treatment,especially those who with the sEPCR value too high, the embolic threatening should be paid attention to.