V因子Leiden突变及蛋白S、蛋白C与脑静脉窦血栓抗凝有效性相关性分析

Correlation between Factor V Leiden mutation,protein S,protein C and anticoagulation for cerebral venous sinus thrombosis

目的:分析V因子Leiden突变及蛋白S、蛋白C低下与脑静脉窦血栓行抗凝治疗有效性的关系。方法:选取2017年5月至2022年2月蚌埠市第三人民医院收治的脑静脉窦血栓的103例患者为研究对象,根据DNA检测及酶联免疫吸附沉淀检测判定患者是否存在V因子Leiden突变及蛋白S、蛋白C水平,分别以单纯V因子突变为观察A组33例,单纯蛋白S、蛋白C低下为观察B组34例,无V因子Leiden突变及蛋白S、蛋白C低下为对照组36例,记录三组在给予抗凝治疗的第3、7、15 d的血栓弹力图参数及INR、APTT的水平,研究比较V因子Leiden突变及蛋白S、蛋白C与脑静脉窦血栓抗凝有效性的关系。结果:观察A组在抗凝治疗第3、7、15 d时凝血反应时间(R)延长水平不明显、血凝块形成速率(K)延长水平不明显、最大血凝块强度(MA)减少水平不明显及凝血功能指标INR升高水平不明显、APTT延长水平不明显,与对照组及观察B组比较,差异具有统计学意义(P<0.05),而观察B组仅在抗凝治疗3 d R延长水平、K延长水平与对照组相比,差异有统计学意义(P<0.05),观察B组在抗凝治疗第7、15 d时R延长水平明显、K延长水平明显、MA减少水平明显及INR升高水平明显、APTT延长水平明显,但和对照组相比,两者差异无统计学意义(P>0.05)。结论:对于V因子Leiden突变的脑静脉窦血栓的患者行抗凝治疗效果较差,对于蛋白S、蛋白C低下的患者行抗凝治疗效果较好,对于无V因子Leiden突变及蛋白S、蛋白C低下的患者抗凝治疗效果最好,V因子Leiden突变及蛋白S、蛋白C低下与脑静脉窦血栓的抗凝有效性存在相关性。

Objective:To analyze the relationship between Factor V Leiden mutation,protein S,protein C and anticoagulation for cerebral venous sinus thrombosis(CVST).Methods:A total of 103 patients with cerebral venous sinus thrombosis in the Third People's Hospital of Bengbu from February 2018 to February 2022 were selected as the research subjects.103 patients were divided into the observation group A(n=33),observation group B(n=34)and control group(n=36)according to DNA and ELISA detection results.Thromboelastography(TEG)parameters,INR and APTT levels of the three groups were recorded on the 3rd,7th and 15th days of anticoagulant treatment,the collected data was analyzed to study the relationship between Factor V Leiden mutation,protein S,protein C and anticoagulation for cerebral venous sinus thrombosis.Results:On the 3rd,7th and 15th days of anticoagulant treatment,no obvious prolongation of coagulation reaction(R)or blood clot kinetics(K)was found in the observation group A.Maximal amplitude(MA)was not significantly decreased,INR level was not significantly increased,and APTT level was not significantly prolonged in the observation group A.Comparing with the control group and observation group B,the differences were statistically significant(P<0.05).While the prolongation of coagulation reaction(R)and blood clot formation in observation group B were only statistically different with the control group on the 3rd days of anticoagulation treatment(P<0.05).On the 7th and 15th days of anticoagulant treatment,significant prolongation of coagulation reaction(R)and blood clot formation(K)was found in the observation group B.Maximal clot strength(MA)was significantly decreased,INR level was significantly increased,and APTT level was significantly prolonged in the observation group B.However,the differences were not statistically significant comparing with the control group(P>0.05).Conclusion:The effect of anticoagulant therapy is poor for CVST patients with Factor V Leiden mutation,but better for CVST patients with low level of protein S and protein C,which could get the best effect for patients without Factor V Leiden mutation or low level of protein S and protein C.Leiden mutation of V factor and low level of protein S and C are correlated with the anticoagulant effectiveness in CVST.