心脏瓣膜疾病手术前后血流动力学异常与vWF和ADAMTS13的关系

Relationship between hemodynamic abnormalities and vWF and ADAMTS13 before and after operation in heart valve diseases

目的:观察血流动力学异常心脏瓣膜疾病(CVDAH)手术前后血管性血友病因子(vWF)、血管性血友病因子裂解蛋白酶(ADAMTS13)的变化。方法:收集泰达国际心血管病医院2018年7月—2019年4月行心脏瓣膜置换手术的CVDAH患者40例为手术组,同期志愿者32名为健康对照组,用vWFL-TOP700凝血仪检测vWF活性(vWF:AC)和vWF抗原(vWF:Ag),用ELISA法检测ADAMTS13抗原(ADAMTS13:Ag),用荧光共振能量转移法检测ADAMTS13活性(ADAMTS13:AC)。比较手术组术前与术后5~7 d峰值流速(V)、最大跨瓣压差(△P),术前、术后1 h、术后1 d、术后5~7 d及对照组vWF:Ag、vWF:AC、ADAMTS13:Ag、ADAMTS13:AC的变化趋势,分析vWF:Ag、vWF:AC、ADAMTS13:Ag、ADAMTS13:AC手术前后各时间段对CVDAH患者血管内皮损伤的诊断价值。结果:手术组术前vWF:Ag、vWF:AC、ADAMTS13:Ag、ADAMTS13:AC与对照组相比,差异均无统计学意义(均P>0.05),术后各时间段vWF:Ag、vWF:AC均高于对照组,ADAMTS13:Ag、ADAMTS13:AC均低于对照组(均P<0.05),vWF:Ag、vWF:AC术后1 d达峰值,5~7 d开始下降;ADAMTS13:Ag及ADAMTS13:AC分别于术后1 d、术后1 h达到谷值,5~7 d开始上升。CVDAH患者术后5~7 d V、△P明显低于术前水平(P<0.05)。结论:CVDAH患者术后vWF的下降趋势、ADAMTS13的上升趋势反映血流剪切应力降低,表明血管内皮损伤减轻。

Objective:To investigate the effect of von Willebrand factor(vWF)and ADAMTS13 dynamic changes in hemodynamic abnormal heart valve disease(CVDAH)patients before and after operation.Methods:A total of 40 CVDAH patients who underwent heart valve replacement surgery from July 2018 and April 2019 in TEDA International Cardiovascular Hospital were collected as the operation group and 32 volunteers in the same period served as healthy control group.vWF activity(vWF:AC)and vWF antigen(vWF:Ag)were detected by vWFL-TOP700 coagulation instrument,ADAMTS13 antigen(ADAMTS13:Ag)was detected by ELISA,and ADAMTS13 activity(ADAMTS13:AC)was detected by fluorescence resonance energy transfer method.Compared the peak flow velocity(V)and the maximum transvalvular pressure(△P)between preoperative and postoperative 5-7 days.The changes of vWF:Ag,vWF:AC,ADAMTS13:Ag and ADAMTS13:AC before operation,1 hour,1 day,5-7 days after operation were observed.The diagnostic values of vWF:AG,vWF:AC,ADAMTS13:Ag and ADAMTS13:AC for vascular endothelial injury in patients with CVDAH were analyzed.Results:There were no significant differences in VWF:AG,vWF:AC,ADAMTS13:Ag and ADAMTS13:AC between the operation group and the control group(all P>0.05).The levels of vWF:Ag and vWF:AC in each period after operation were higher than those in the control group,but the levels of ADAMTS13:Ag and ADAMTS13:AC were lower than those in the control group(all P<0.05).vWF:Ag and vWF:AC reached the peak at 1 day and decreased at 5-7 days after operation.ADAMTS13:Ag and ADAMTS13:AC reached valley point at 1 day and 1 hour after operation respectively,then raised at 5-7 days.V and△P of CVDAH patients were significantly lower than those before operation in 5-7 days after operation(both P<0.05).Conclusion:The decreasing trend of vWF and the increasing trend of ADAMTS13 in patients with CVDAH reflect the decrease of shear stress in blood flow,and it means the endothelium is less damaged.