HLA-B27+强直性脊柱炎患者凝血功能紊乱与炎性活动指标的相关性分析

Correlation analysis of coagulation disorders and inflammatory activity indexes in patients with HLA-B27+ankylosing spondylitis

目的探讨人类白细胞表面抗原B27阳性(HLA-B27+)强直性脊柱炎(AS)患者凝血功能紊乱与炎性活动指标的相关性。方法收集2019年1月至2020年5月在甘肃省庆阳市中医医院就诊的55例HLA-B27^(+)AS患者和50例健康对照人群的临床资料和血液样本,检测凝血四项[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)]、D二聚体(D-D)、纤维蛋白(原)降解产物(FDP)、红细胞沉降率(ESR)、C反应蛋白(CRP)、血小板计数(PLT)、血栓形成相关因子[血栓素A_(2)(TXA_(2))、前列环素(PGI_(2))、血小板颗粒膜蛋白(GMP140)、纤溶酶原激活剂抑制剂(PAI)]水平,并评估Batch疾病活动度指数(BASDAI),并分为疾病活动亚组(BASDAI≥4分)和病情缓解亚组(BASDAI<4分)。结果与健康对照组相比,AS组患者APTT均值及血清PGI_(2)水平降低,而血清FIB、D-D、FDP、TXA_(2)、GMP140、PAI、CRP、ESR水平以及PLT绝对计数显著升高(P<0.05)。与病情缓解亚组AS患者相比,疾病活动亚组AS患者血清D-D、TXA_(2)、GMP140、PAI、CRP、ESR水平和PLT绝对计数升高,而血清PGI_(2)水平则降低(P<0.05)。而且AS组患者D-D、PLT、TXA_(2)、GMP140、PAI、PGI_(2)与疾病炎性活动指标CRP、ESR、BASDAI均密切相关(P<0.05)。结论HLA-B27^(+)AS患者普遍存在凝血-纤溶功能异常,尤其是处于疾病活动期患者,更易表现出血液高凝状态。

Objective To investigate the correlation of coagulation disorders and inflammatory activity indexes in patients with human leukocyte antigen-B27positive(HLA-B27^(+))ankylosing spondylitis(AS).Methods The clinical data and blood samples of 55patients with HLA-B27^(+) AS patients and 50healthy controls were collected from January 2019to may 2020in Qingyang Hospital of Traditional Chinese Medicine.Prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),thrombin time(TT)D-Dimer(D-D),fibrin/fibrinogen degradation products(FDP),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),platelet count(PLT),thromboxane A_(2)(TXA_(2)),prostaglandin I_(2)(PGI_(2)),platelet granular membrane protein 140(GMP140),plasminogen activator inhibitor(PAI)were detected.And bath ankylosing spondylitis disease activity index(BASDAI)was used to evaluated the pathogenetic activity of AS patients,who were divided into stable subgroup(BASDAI<4)and active subgroup(BASDAI≥4).Results Compared with the healthy control group,APTT and serum PGI_(2)levels in AS group were decreased,while serum FIB,D-D,FDP,TXA_(2),GMP140,PAI,CRP,ESR levels and PLT counts were increased(P<0.05).Compared with as patients in stable subgroup,serum D-D,TXA_(2),GMP140,PAI,CRP,ESR levels and PLT counts in active subgroup were increased,while the serum PGI_(2)level was decreased(P<0.05).Moreover,D-D,PLT,TXA_(2),GMP140,PAI,PGI_(2)in AS group were closely correlated with CRP,ESR and BASDAI(P<0.05).Conclusion Coagulation fibrinolysis dysfunction is common in HLA-B27^(+) AS patients,especially in patients with active disease,they are more likely to show hypercoagulability.