儿童过敏性紫癜不同时期凝血功能状态检测及分析

The status and mechanism of coagulation in children with Henoch-Schonlein purpura in different stages

目的 研究儿童过敏性紫癜 (HSP)发作期及缓解期凝血状态的改变情况及其机制。方法 2 0 0 1～2 0 0 3年深圳市儿童医院收治的HSP患儿共 6 0例 ,根据发病期和缓解期的不同 ,相应分为HSP发作组 (30例 )和HSP缓解组 (30例 ) ,检测凝血酶原时间比 (PTR)、血浆D 二聚体 (D dimer)及组织因子途径抑制物 (TFPI)水平 ,并与对照组 35例健康体检儿童比较。结果 两组HSP患儿的PTR与对照组比较差异无显著性 (均P >0 0 5 ) ;HSP发作组血浆D dimer明显升高 (P <0 0 5 ) ,而HSP缓解组血浆D dimer浓度下降 ,与对照组差异无显著性(P >0 0 5 ) ;HSP发作组血浆TFPI含量高于对照组 (P <0 0 5 ) ,HSP缓解组降至正常水平 ,和对照组比较差异无显著性 (P >0 0 5 )。结论 HSP患儿发作期凝血解溶状态处于高活动状态 ,随着病情进入缓解期高凝状态可恢复正常 ;TFPI在HSP患儿发作期可能具有防止血管内凝血活动过度和扩散的重要作用。

Objective To study the changes and mechanism of blood coagulation in children with Henoch-Schonlein purpura(HSP) in different stages.Methods Of the 60 HSP children,30 suffering from the attack of the disease were classified as the episode group,the other 30 in remission stage as the remission group.Prothrombin time rate (PTR),plasma levels of D dimer and tissue factor pathway inhibitor(TFPI) were determined and compared whith those of 35 normal control children.Results Compared with the control group,both the episode group and the remission group had no changes in terms of the PTR,but the plasma levels of D-dimer and TFPI were higher in the episode group than in the control group;there was no significant difference in D-dimer and TFPI levels between the remission and the control group.Conclusion The characteristic change of coagulation in children suffering from the attack of HSP is hypercoagulability,which may return to normal at remission time.TFPI may play an important role in protecting children with HSP from overactive coagulation even disseminated intravascular coagulation.