地中海贫血患者组织因子和组织因子途径抑制物检测的临床意义

Clinical Significance of Detecting Tissue Factor and Tissue Factor Pathway Inhibitor in Thalassemia Patients

目的:观察地中海贫血(地中海贫血)患者脾切除术前及术后1年外周血中E-选择素、凝血酶抗凝血酶复合物(TAT)、凝血酶原片段1+2(F1+2)、组织因子(TF)、组织因子途径抑制物(TFPI)含量的变化,探讨地中海贫血患者脾切除前后血凝状态的改变。方法:采用酶联免疫吸附法分别测定30例地中海贫血患者腹腔镜脾切除术前后血浆中E-选择素、TAT、F1+2、TF及TFPI的水平。选择30例健康体检者作为对照组。结果:地中海贫血患者脾切除术后1年患者血浆中E-选择素、TAT、 F1+2、TF、TFPI水平显著高于术前及对照组。地中海贫血患者脾切除术前血浆中E-选择素、TAT、 F1+2显著高于对照组。地中海贫血患者切脾前后血浆TF与TFPI水平均呈正相关(切脾前r=0.65,P <0.001;切脾后r=0.92,P <0.001);切脾后TF水平与TAT(r=0.75, P <0.001)及F1+2(r=0.78, P <0.001)呈正相关;切除脾后血浆TFPI水平与TAT(r=0.84, P <0.001)及F1+2(r=0.85, P <0.001)呈正相关。结论:地中海贫血患者脾切除后血小板增多、内皮细胞活化受损、促凝血因子增多,血液处于血栓前状态。TF/TFPI在地中海贫血脾切除患者血栓形成的病理过程中起重要作用,并可作为评价血液高凝状态变化的参考指标。

Objective:To investigate the changes of E-selectin,thrombin-antithrombin complex(TAT),prothrombin fragment 1+2(F1+2),tissue factor(TF)and tissue factor pathway inhibitor(TFPI)before and one year after splenectomy in thalassemia patients.Methods:A total of 30 thalassemia patients undergoing electric laparoscopic splenectomy and 30 normal controls(NC)were enrolled in the study.Plasma levels of E-selectin,TAT,F1+2,TF and TFPI were detected by enzyme-linked immuno sorbent assay(ELISA).Results:One year after splenectomy,the plasma concentrations of E-selectin,TAT,F1+2,TF,TFPI were significantly higher than those in both preoperative and NC groups.Levels of E-selectin,TAT,F1+2 before splenectomy were significantly higher than those in NC groups.In addition,there was a positive correlation between plasma TF and TFPI level before and after splenectomy,and the levels of TF and TFPI positively correlated with TAT and F1+2,respectively.Conclusion:After splenectomy,the platelet count increases,the activity of endothelial cells is injured,the procoagulant factor increases,the blood is in procoagulant state,the TF/TFPI shows an importent role in the thrombosis of thalassemia patieints after splenectomy and may be used to evaluate the prothrombotic state of this diasease.