犬实验性肺血栓栓塞症后血清乳酸脱氢酶同工酶3和血浆D-二聚体的动态研究

Changes of D-dimers and LDH isoenzymes after experimental pulmonary thromboembolism in Dogs

目的 动态监测犬肺血栓栓塞症 (PTE)后血清乳酸脱氢酶同工酶 3(L DH3)与血浆 D-二聚体的变化 ,探讨两者在急性 PTE诊断中的价值。方法 采用健康杂种犬 18只 ,随机分为三组。栓塞 组采用自体血加凝血酶及人纤维蛋白原制备的自体血栓 ,由股静脉输入建立急性 PTE模型。栓塞 组不加人纤维蛋白原 ,余同栓塞 组。对照组由股静脉输入生理盐水加人纤维蛋白原。三组均于栓塞前后做肺动脉造影及螺旋 CT血管造影 ,栓塞前及栓塞后多时点留取血样测 L DH3及血浆 D-二聚体浓度。结果 肺动脉造影及螺旋 CT血管造影均证实犬 PTE模型制备成功。栓塞 组血浆 D-二聚体于栓塞后 30 m in明显上升 ,2 4 h后明显下降 ,自身前后比较及与栓塞 组、对照组比较 ,差异有显著性 (P<0 .0 5 )。栓塞 ( 、 )组栓塞后 2 h至 4 d L DH3明显升高 ,与栓塞前及对照组比较差异有显著性 (P<0 .0 5 )。结论 血浆 D-二聚体、L DH3在急性 PTE早期有一个相对特征性的动态变化过程 ,联合检测 D-二聚体、L DH3有助于急性 PTE的早期诊断。

Objective To study the changes of D-dimer and LDH 3 after experimental pulmonary thromboembolism (PTE) and to evaluate it's value for the diagnosis of PTE. Methods 18 healthy mongrel dogs were divided into three groups, 6 in the embolism groupⅠ,6 in the embolism group Ⅱ and 6 in the control group. Acute PTE mo- dels were established with injection of autologous blood clots through the femoral vein. Thrombin and human fibrinogen were delivered into clots in the embolism group Ⅰ. Thrombin were delivered into clots in the embolism group Ⅱ. The control group received normal saline and thrombin with the same way. D-dimer and LDH 3 were measured before and 30min, 1h, 2h, 4h, 24h, 48h, 3d, 4d, 5d, 7d, 10d after embolism. The plasma levels of D-dimer were measured by the method double antibodies ELISA. The serum levels of LDH 3 were measured by rapid electrophorosis. Results The plasma levels of D-dimer elevated at 30min after embolism, increased to the highest at 1h to 2h, and then decreased at 24h. The serum levels of LDH 3 increased at 4h after embolism. And up to the highest at 24h to 48h, then decreased at 3d to 4d after embolism. Conclusion To monitor the levels changing dynamically of the plasma D-dimer and the serum LDH 3 were benefited to the diagnosis of PTE in the early stage.