慢性下肢静脉曲张性溃疡感染对凝血指标及RANTES表达的影响

Effect of chronic variceal ulcer infection of lower extremities on blood coagulation indexes and RANTES expression

目的探究慢性下肢静脉曲张性溃疡(Chronic varicose ulcer of lower extrenity,CLU)感染对凝血指标及调节活化正常T细胞表达和趋化因子(Regulating the expression of activated normal T cells and chemokines,RANTES)表达的影响。方法选择2017年1月-2019年1月于常州市第二人民医院确诊的原发性下肢静脉曲张的住院治疗患者120例为研究对象,根据是否发生溃疡以及患肢渗出物的细菌培养结果,分为下肢静脉曲张组51例(CVI组)、仅合并溃疡者40例(CLU组)、CLU合并感染者29例(CLU合并感染组)。采用电阻法检测血小板参数[血小板数(PLT)、血小板体积分布宽度(PDW)、血小板平均体积(MPV)]。采用凝固法检测凝血功能指标[纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)]。采用逆转录-聚合酶链反应(RT-PCR)二步法检测RANTES mRNA表达情况。采用酶联免疫吸附(ELISA)法检测血清炎性因子[白细胞介素-6(IL-6)和IL-10]。结果CLU合并感染组的PLT为(291.28±43.57)×10^9/L高于CVI组(205.31±40.22)×10^9/L和CLU组(246.35±41.24)×10^9/L;而MPV为(6.35±0.69)fl低于CVI组(8.23±0.81)fl和CLU组(7.16±0.76)fl(P<0.001);CLU合并感染组的FIB为(4.71±0.89)g/L高于CVI组(3.12±0.73)g/L和CLU组(3.89±0.81)g/L;而PT为(11.98±0.52)s低于CVI组(13.23±0.62)s和CLU组(12.40±0.58)s(P<0.001);CLU合并感染组的RANTES mRNA表达水平为(2.59±0.30)高于CVI组和CLU组(P<0.001);CLU合并感染组的血清IL-10为(125.35±29.84)pg/ml低于CVI组和CLU组;而IL-6为(40.12±7.38)pg/ml高于CVI组和CLU组(P<0.001)。结论慢性下肢静脉曲张性溃疡患者血液呈高凝状态,感染会进一步加重血液状态,增加静脉血栓风险。RANTES高表达和炎性因子IL-6、IL-10水平变化可能与溃疡形成和感染有关。

OBJECTIVE To investigate the effect of chronic variceal ulcer infection of lower extremities on coagulation indexes and regulation of activated normal T cell expression and chemokine expression(RANTES).METHODS Totally 120 patients with primary varicose veins of lower extremities diagnosed in Changzhou Second People’s Hospital between Jan.2017 and Jan.2019 were selected as the subjects.According to the results of ulcers and bacterial culture of exudates from the affected limbs,they were divided into 51 cases with varicose veins of lower extremities group(CVI group),40 cases with only ulcers(CLU group),and 29 cases with CLU co-infection(CLU co-infection group).Platelet parameters[platelet count(PLT),platelet distribution width(PDW),mean platelet volume(MPV)]were detected by resistance method.Coagulation function indicators[fibrinogen(FIB),prothrombin time(PT),activated partial thromboplastin time(APTT)]were detected by coagulation method.The expression of RANTES mRNA was detected by reverse transcription polymerase chain reaction(RT-PCR)two-step method.Levels of serum inflammatory factors[Inteleukin-6(IL-6),Inteleukin-10(IL-10)]were detected by enzyme-linked immunosorbent assay(ELISA).RESULTS The PLT of the CLU co-infection group was(291.28±43.57)×10^9/L significantly higher than that of the CVI group(205.31±40.22)×10^9/L and the CLU group(246.35±41.24)×10^9/L,while the MPV was(6.35±0.69)fl,significantly lowler than that of the CVI group(8.23±0.81)fl and the CLU group(7.16±0.76)fl(P<0.001).The FIB of the CLU co-infection group was(4.71±0.89)g/L,significantly higher than that of the CVI group(3.12±0.73)g/L and the CLU group(3.89±0.81)g/L while the PT was(11.98±0.52)s,significantly shorter than that of the CVI group(13.23±0.62)s and the CLU group(12.40±0.58)s(P<0.001).The expression level of RANTES mRNA in the CLU co-infection group was(2.59±0.30),significantly higher than that in the CVI group(2.02±0.27)and the CLU group(2.28±0.31)(P<0.001).Serum IL-10 level in the CLU co-infection group was(125.35±29.84)pg/ml,significantly lower than that in the CVI group and the CLU group.IL-6 level was,significantly higher than that in the CVI group and the CLU group(P<0.001).CONCLUSION Patients with chronic variceal ulcer of lower extremities had hypercoagulable blood,and infection will further aggravated the blood state and increased the risk of venous thrombosis.High expression of RANTES and changes of inflammatory factors like IL-6 and IL-10 may be associated with ulcer formation and infection.