原发性干燥综合征患者凝血状态的变化及临床意义

Changes of Coagulation Status in Patients with Primary Sjogren 's Syndrome and Its Clinical Significance

目的探讨原发性干燥综合征(p SS)患者凝血状态的变化及临床意义。方法选取39例原发性干燥综合征确诊患者作为实验组,39名健康体检者作为对正常对照组,利用全自动血凝仪测定常规凝血指标,即血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(fibrinogen,FIB)、D-二聚体(D-D),以及多种凝血、抗凝和纤溶标志物,即凝血因子Ⅷ促凝活性(FⅧ:C)、血管性血友病因子抗原(VWF:Ag)、血浆抗凝血酶活性(AT:A)、纤溶酶原活性(PLG:A)、蛋白C活性(PC:A)及狼疮抗凝物(LAC)。对测定结果采用两样本均数t检验进行比较分析,并采用受试者工作特征(ROC)曲线分析各指标的诊断效能。结果与正常对照组比较,原发性干燥综合征患者的PT、APTT、LAC和PC:A水平比较,差异无统计学意义(P> 0. 05);D-D、FIB、FⅧ:C、VWF:Ag水平明显升高,AT:A、PLG:A水平明显降低(P均<0. 05)。ROC曲线分析D-D、VWF:Ag的曲线下面积分别为0. 972、0. 722,其余各项均<0. 7。结论原发性干燥综合征患者体内凝血状态异常,处于血栓前状态,常规凝血指标检测有助于了解疾病进展,D-D、VWF:Ag可作为协助诊断原发性干燥综合征的非特异性反应指标。

Objective To investigate the changes and clinical significance of coagulation status in patients with primary Sjogren′s syndrome(pSS).Methods Thirty nine patients with primary Sjogren′s syndrome were selected as the experimental group and 40 healthy persons were used as control group.The coagulation parameters were measured by automatic coagulation analyzer,including prothrombin time(PT),activated partial thromboplastin time(APTT),plasma fibrinogen(FIB),D-dimer(D-D),and a variety of coagulation,anticoagulation and fibrinolysis markers,including plasma coagulation factorⅧ(FⅧ:C),Von Willebrand factor antigen(VWF:Ag),plasma antithrombin activity(AT:A),plasminogen activity(PLG:A),protein C activity(PC:A)and lupus anticoagulant(LAC).The results were analyzed by Two-sample t-test,and the diagnostic efficacy of each index was analyzed by using the receiver operating characteristic(ROC)curve.Results Compared with the normal control group,the levels of PT,APTT,LAC and PC:A in patients with primary Sjogren′s syndrome had no significant difference(P>0.05).D-D,FIB,FⅧ:C,VWF,and the levels of AT:A and PLG:A were significantly decreased(P<0.05).The area under the ROC curve of D-D and VWF:Ag were 0.972 and 0.722,the rest are less than 0.7.Conclusion The coagulation status of patients with primary Sjogren′s syndrome is abnormal in thrombosis.Routine coagulation index test can help to understand the progression of disease.D-D,VWF:Ag can be used as a non-specific response index to assist in the diagnosis of primary Sjogren′s syndrome.