梗阻性黄疸患者血浆可溶性P-选择素与内毒素的关系及其在凝血障碍中表达的意义

Relationship between plasma soluble P-selectin and endotoxin in the patient with obstructive jaundice and the implication of soluble P-selectin in the dysfunction of blood coagulation

目的 探讨梗阻性黄疸 (OJ)患者血浆可溶性P 选择素 (sP selectin)与内毒素 (ET )的关系及其在凝血障碍中表达的意义。方法 将 3 3例胆总管结石并OJ患者和 3 1例急性胆囊炎并胆囊结石无OJ患者分为梗黄组和无黄组 ,2 5例健康人为健康组 ,3组患者测定血浆可溶性P 选择素、ET、D 二聚体 (D d)、纤维蛋白原 (FBG)、血清纤维蛋白原降解产物 (FDP)、活化部分凝血活酶时间 (KPTT)、凝血酶时间 (TT)。结果 梗黄组和无黄组可溶性P 选择素含量与ET含量有直线相关 (P <0 .0 1) ;在相同ET含量时 ,梗黄组的可溶性P 选择素 (3 5 1.90± 93 .83 ) μg/L高于无黄疸组[(2 3 3 .3 2± 82 .12 ) μg/L ,P <0 .0 1] ;梗黄组D d、FDP[(2 .14± 0 .3 7)mg/L、(15 .13± 0 .46)mg/L]高于无黄组 [(0 .76± 0 .2 7)mg/L、(6.2 1± 0 .3 9)mg/L] (P <0 .0 1) ;梗黄组可溶性P 选择素与D d、FDP之间均正相关 (P <0 .0 1)。结论 OJ是ET致血管内皮细胞损伤和血小板活化的敏感性因素 ,OJ患者表现为代偿性弥散性血管内凝血。

Objective To investigate the relationship between soluble P-selectin (sP-selectin) and endotoxin (ET) in the patient with obstructive jaundice (OJ) and the implication of sP-selectin in the dysfunction of blood coagulation.Methods Thirty-three cases of choledocholith with OJ (OJ group) and 31 cases of acute cholecystitis with cholecystolithiasis without OJ (non-OJ group) were studied.Twenty health people served as control group.Plasma sP-selectin,ET,D-dimer (D-d),fibrinogen (FBG),serum fibrinogen degradation product (FDP),kaolin partial thromboplastin time (KPTT) and thrombin time (TT) were detected in the three groups.Results There was significant correlations between sP-selectin and ET in the OJ group and non-OJ group ( P <0.01).At the same level of ET,sP-selectin level in the OJ group (351.90±93.83) μg/L was significantly higher than in the non-OJ group (233.32±82.12) μg/L( P <0.01).D-d and FDP in the OJ group [(2.14±0.37) mg/L and (15.13±0.46) mg/L respectively] were significantly higher than in the non-OJ group [(0.76±0.27) mg/L and (6.21±0.39) mg/L,respectively] ( P <0.01).In the OJ group,sP-selectin had positive corrections with D-d and FDP.Conclusion OJ is the predothelial factor for endotoxin-induced endothelial cell injury and platelet activation.The dysfunction of blood coagulation in the OJ patient is compensatory disseminated intranascular coagulation.