血栓性疾病实验诊断指标的应用研究

Evaluation of laboratory tests in diagnosis of used for thrombotic diseases

目的 评价血管内皮细胞、凝血、纤溶、血小板活化指标在血栓性疾病诊断中的价值。方法 对 5 1例血栓性疾病患者、2 1例非血栓性疾病患者以及 35例正常人 ,分别以ELISA法检测其血管性血友病因子 (vWF :Ag)、组织因子 (TF)、凝血酶原片段 1+2 (F1+2 )、组织型纤溶酶原激活物 (t PA :Ag)、血栓烷B2 (TXB2 )和以发色底物法检测纤溶酶原激活物抑制剂活性 (PAI:Ac)及α2 纤溶酶抑制剂活性 (α2 PI:Ac)等。结果 血栓病组与非血栓病组患者的t PA :Ag、PAI:Ac、α2 PI:Ac、vWF :Ag、F1+2都较对照组高 (P <0 0 5 ) ,其中α2 PI:Ac、vWF :Ag、F1+2在血栓病组和非血栓病组之间无显著性差异 (P >0 0 5 ) ;血栓病组的血浆TXB2 、TF较非血栓病组偏高 ,但无显著性差异 (P >0 0 5 ) ;常规止凝血试验如PT、APTT、FIB和PLT在血栓病组和非血栓病组之间均无显著性差异 (P >0 0 5 )。t PA :Ag的诊断敏感度、特异度、诊断比数比以及ROC曲线下面积分别为 6 6 7%、6 6 7%、4 0和 0 6 90 ,而PAI:Ac分别为 94 1%、6 0 7%、2 4 7和 0 84 9。结论 本研究结果提示 ,PAI:Ac在诊断血栓性疾病中的敏感度较高 ,其次为t PA ,但需扩大样本进行前瞻性研究和证实 ;其它指标包括vWF :Ag、α2 PI:Ac、TF、F1+2、TXB2

Objective To evaluate laboratory tests in diagnosis of thrombotic diseases with the dysfunction of endothelium, coagulation, fibrinolysis and platelet. Methods We selected 51 patients with thrombotic diseases, 21 non-thrombotic patients, and 35 healthy peoples as control. Plasma von Willebrand factor antigen(vWF:Ag), tissue factor(TF), prothrombin fragment 1+2(F1+2), tissue-plasminogen activator antigen(t-PA:Ag), thromboxane B 2(TXB 2) were detected by ELISA, plasminogen activator inhibitor activity(PAI:Ac) and α 2-plasmin inhibitor activity(α 2-PI:Ac) were detected by chromogenic assays. Results The level of t-PA:Ag, PAI:Ac, α 2-PI:Ac, vWF:Ag and F1+2 was significantly higher in thrombotic or non-thrombotic group than that of control( P <0 05). However, there is no significant difference for α 2-PI:Ac, vWF:Ag, F1+2 between thrombotic and non-thrombotic group( P >0 05). The diagnostic sensitivity, specificity, diagnostic odds ratio(DOR), and area under ROC curves(AUC) of t-PA:Ag for thombotic patients were 66 7%, 66 7%, 4 0, and 0 690, respectively, which was compared with 94 1%, 60 7%, 24 7, and 0 849 for PAI:Ac, respectively. Conclusion Our results indicate that:(1) PAI:Ac and t-PA:Ag may be useful as a screening test in diagnosis of thombotic diseases; (2) vWF:Ag, α 2-PI:Ac, TF, F1+2, TXB 2, and PT, APTT, FIB, PLT, were less sensitive in diagnosis of thrombotic diseases.