溶血和脂血对血浆中抗凝蛋白及纤溶系统的影响

The effect of hemolysis and lipemia on anticoagulation protein activity and fibrinolytic system in plasma

目的探讨标本溶血和脂血对血浆中抗凝蛋白和纤溶系统的影响。方法用真空采血管抽取50例住院患者空腹静脉血各两管,无黄疸、脂血、溶血,即刻以3 000r/min离心10min,立即测定抗凝血酶Ⅲ(ATⅢ)、蛋白C(PC)、蛋白S(PS)、D-二聚体(D-Dimer)、纤维蛋白降解产物(FDP)水平,作为对照组。然后每管分装3份,同时制备不同水平溶血和脂血标本,分别测定上述抗凝和纤溶指标,与对照组结果进行比较。结果不同程度溶血标本与对照组相比,轻、中度溶血患者5种指标水平差异无统计学意义(P>0.05);重度溶血组ATⅢ活性显著升高(P<0.05),PC活性显著降低(P<0.05),而PS活性、D-Dimer、FDP水平差异无统计学意义(P>0.05)。不同程度脂血标本与对照组相比,轻、中度脂血患者5种指标水平差异无统计学意义(P>0.05);重度脂血组ATⅢ活性显著降低(P<0.05),PC和PS活性、D-Dimer、FDP水平显著升高(P<0.05)。结论为保证抗凝蛋白活性和纤溶系统水平,应严格控制分析前质量控制。

Objective To investigate the influence of hemolysis and lipemia on anticoagulation protein activity and fibrinolytic system in plasma.Methods Blood from 50inpatients by vacutainer were collected,without jaundice,lipemia and hemolysis.And the blood was centrifuged at 3 000r/min for 10minutes,which were selected as control group.AntithrombinⅢ(ATⅢ),protein C(PC),protein S(PS),D-Dimer,fibrin degradation product(FDP)level were detected.Then the left plasma were divided into three grades(mild,moderate and severe hemolysis)based on the level of hemoglobin,the concentrations of ATⅢ,PC,PS,D-Dimer,FDP were detected three times.The another left plasma were divided into three levels(mild,moderate and severe lipemia)based on the level of triglycerides,and the levels of ATⅢ,PC,PS,D-Dimer and FDP after adding the fat emulsion were determined.The results were statistically analyzed.Results There were statistically significances of ATⅢand PC between control group and severe hemolytic group(P<0.05).There were no significances for PS,D-Dimer,FDP between control group and mild,moderate hemolytic group(P>0.05).There were statistically significances for ATⅢ,PC,PS,D-Dimer and FDP between control group and severe lipemia group(P<0.05).But there was no significance of the indicators between mild and moderate lipemia group(P>0.05).ATⅢof severe lipemia had decreased significantly,while PC,PS,D-Dimer and FDP had increased significantly(P<0.05).Conclusion In order to guarantee the activity of anticoagulant protein and the level of fibrinolysis system,quality control before analysis should be strictly controlled.