急性肺损伤_急性呼吸窘迫综合征患者凝血纤溶系统的变化_叶伶VIP免费

复旦学报(医学版)FudanUnivJMedSci2008Sep,35(5)急性肺损伤/急性呼吸窘迫综合征患者凝血纤溶系统的变化叶伶金美玲v徐晓波高磊白春学朱蕾(复旦大学附属中山医院呼吸内科上海200032)=摘要>目的观察急性肺损伤/急性呼吸窘迫综合征(acutelunginjury/acuterespiratorydistresssyndrome,ALI/ARDS)患者血浆蛋白C(proteinC,PC)活性的改变以及PC、凝血酶调节蛋白(thrombomodulin,TM)和纤溶酶原活化剂抑制物-1(plasminogenactivatorinhibitor-1,PAI-1)的抗原含量的改变,探讨ALI/ARDS对全身凝血纤溶系统的影响。方法分ALI/ARDS组(24例)和健康对照组(12例)。采用酶联免疫吸附试验(ELISA)分别测定两组静脉血血浆PC、TM、PAI-1的抗原含量,采用发色底物法测定PC活性。对ALI/ARDS患者进行APACHEÒ及多器官功能障碍综合征(multipleorgandysfunctionsyndrome,MODS)评分。将ALI/ARDS患者依据脏器衰竭的数目和预后进行亚组分析。结果ALI/ARDS组PC活性和PC抗原均低于健康对照组(前者P<0.01,后者P<0.05);TM、PAI-1抗原含量均显著高于健康对照组(P<0.01)。ALI/ARDS组血浆PC活性分别与APACHEÒ评分和MODS评分存在着显著的负相关性(P<0.01);ALI/ARDS组PAI-1抗原含量与两评分均存在着正相关性(前者P<0.01,后者P<0.05)。ALI/ARDS组PC、TM的抗原含量与两评分均无显著相关性。单纯呼吸衰竭亚组血浆PC活性显著高于MODS亚组(P<0.01);两亚组间PC、TM、PAI-1的抗原含量均无统计学差异。存活亚组和病死亚组间血浆PC活性,PC、TM、PAI-1的抗原含量均无统计学差异。结论ALI/ARDS患者存在着全身凝血纤溶系统的异常改变,即促凝血活性增加和纤溶活性降低;且与疾病的严重程度存在着一定的相关性。=关键词>急性肺损伤;急性呼吸窘迫综合征;凝血纤溶;蛋白C;凝血酶调节蛋白;纤溶酶原活化剂抑制物-1=中图分类号>R563.8=文献标识码>B卫生部部属(管)医疗机构临床学科重点项目(2005-2007);上海市重点学科建设项目(B115)vCorrespondingauthorE-mail:mljin118@yahoo.com.cnThechangesofcoagulationandfibrinolysissysteminacutelunginjury/acuterespiratorydistresssyndromeYELing,JINMe-ilingv,XUXiao-bo,GAOLei,BAIChun-xue,ZHULei(DepartmentofRespiration,ZhongShanHospital,FudanUniversity,Shanghai200032,China)=Abstract>ObjectiveToexploretheinfluenceofacutelunginjury/acuterespiratorydistresssyndrome(ALI/ARDS)oncoagulationandfibronolysissystembyexaminingtheplasmalevelsofproteinC(PC),thrombomodulin(TM)andplasminogenactivatorinhibitor-1(PAI-1).MethodsThestudywasdividedintotwogroups:ALI/ARDSpatients(n=24)andnormalvolunteers(n=12).TheplasmalevelsofPCantigen,TMantigenandPAI-1antigenweredeterminedbyenzyme-linkedimmunosorbentassay(ELISA).TheplasmalevelofactivePC(APC)wasdeterminedbychromogenicsubstratemethod.Furthermore,ALI/ARDSpatientswereestimatedwithAPACHEÒscoreandmultipleorgandysfunctionsyndrome(MODS)score.ALI/ARDSpatientswerestudiedbydividingpatientsintosubsetsbasedonthenumbersoforgandysfunctionandprognosis.ResultsTheplasmalevelsofAPCandPCantigenweresignificantlylowerinpatientswithALI/ARDSthanthoseofthenormalcontrols(P<0.05);thelevelsofTMantigenandPAI-1antigenweresignificantlyhigherin671复旦学报(医学版)2008年9月,35(5)ALI/ARDSpatientsthanthoseinthenormalcontrols(P<0.01).Furthermore,therewasasignificantnegativecorrelationbetweentheplasmalevelofAPCinpatientsandAPACHEÒscoreandMODSscore(P<0.01);apositivecorrelationwasfoundbetweenthelevelofPAI-1antigenandAPACHEÒscore(P<0.01)orMODSscore(P<0.05).However,therewasnocorrelationbetweenthelevelsofPCantigen,TMantigenandAPACHEÒscoreorMODSscore.TheplasmalevelofAPCinpatientswithsinglelungdysfunctionwassignificantlyhigherthanthatinpatientswithMODS(P<0.01);however,therewasnodifferenceinthelevelsofPCantigen,TMantigenandPAI-1antigenbetweenpatientswithsingl...