老年周围动脉闭塞性疾病患者血栓前状态的初步研究

Investigation on prethrombotic state of peripheral article occlusive disease in the elderly

目的 探讨老年周围动脉闭塞性疾病 (PAOD)患者是否存在血栓前状态 (PTS)及其临床意义。方法 检测 33例确诊为老年 PAOD患者的血浆血小板α颗粒膜蛋白 - 1 4 0 (GMP- 1 4 0 )、血管性假血友病因子 (v WF)、纤维蛋白原 (FIB)、纤溶酶原 (PLG)和 D-二聚体 (DD)以及凝血酶 -抗凝血酶 复合物 (TAT)水平 ,并分别与 40例健康老人及 30例具有心血管危险因素的非 PAOD患者进行比较。结果 老年 PAOD组的 GMP- 1 4 0(1 4 .0 6± 2 .1 8μg/ L )、DD(2 .92± 1 .3μg/ L)、v WF(1 0 4 .42 %± 31 .4%)及 FIB(60 6.8± 1 1 7.8mg/ dl)水平显著高于健康对照组 (依次为 8.2 3± 1 .86μg/ L、0 .35± 0 .1 8μg/ L、53.67%± 1 1 .33%及 2 4 2 .3± 41 .7mg/ dl) (P<0 .0 0 0 1 )和心血管危险因素组 (依次为 1 1 .97± 1 .96μg/ L、1 .0 6± 0 .53μg/L、75.8%± 4.59%及 41 3.4± 67.78mg/ dl) (P<0 .0 0 1 ) ,而 PLG活性、TAT水平各组间无显著差异。结论 老年 PAOD患者存在血栓前状态 ,且与内皮功能失调密切相关 ;积极使用抗血小板制剂和抗凝剂 ,改善血管内皮功能是 PAOD治疗的核心之一。

Objective To detect whether the prethrombotic state (PTS) existed in the old patients of peripheral arterial occlusive disease (PAOD). Methods Six factors reflecting PTS including platelet a-granular membrane protein-140 (GMP-140), von willebrand factor (VWF), fibrinogen (FIB), plasminogen (PLG), d-dimer (DD) and the complex of thrombin-antithrombin Ⅲ(TAT) were tested in PAOD patients and compared with those of the old healthy controls and non-PAOD patients with cardiac risk factors. Results The levels of GMP-140 (14.06±2.18 ug /L ), DD (2.92±1.3 ug/L), vWF(104.42%±31.4%) and FIB (606.8±117.8 mg/dl) were higher in PAOD patients than those in healthy control group (8.23±1.86 μg/L, 0.35±0.18 μg/L, 53.67%±11.33% and 242.3±41.7 mg/dl, respectively) ( P <0.000 1) and cardiac risk factors group (11.97±1.96 μg/L, 1.06±0.53 μg/L, 75.8%±4.59% and 413.4±67.78 mg/dl, respectively, P <0.001). But the activity of PLG and the level of TAT in different groups have no significant difference. Conclusions PTS existed in old PAOD patients, and it had close relationship with endothelial dysfunction. More attention should be paid to the use of anti-platelet or anticoagulative agents and amelioration of vascular endothelial function in the treatment of PAOD.