肺血栓栓塞症患者血小板功能和血清抗心磷脂抗体的变化及意义

目的　探讨肺血栓栓塞症 (PTE)患者溶栓和抗凝治疗前后血小板功能和血清抗心磷脂抗体 (ACA)的变化及临床意义。方法　选择经螺旋CT肺动脉造影确诊的PTE患者 4 8例为病例组 ,年龄、身高、体重相匹配的健康者 2 0名为对照组。用流式细胞仪检测血小板膜上P 选择素、糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)的变化 ;酶联免疫吸附试验 (ELISA)法检测血浆血栓素B2 (TXB2 )、6 酮 前列腺素F1α(6 Keto PGF1α)、血管性假血友病因子 (vWF)、D 二聚体和血清ACA ,并比较溶栓和抗凝治疗前及治疗 1周时各项指标的变化。结果　病例组P 选择素、GPⅡb/Ⅲa、vWF、TXB2 、D 二聚体、TXB2 / 6 Keto PGF1α(T/K)分别为 (12 4 2± 7 0 3) %、(19 6± 12 5 ) %、(3 8± 1 9)mg/L、(194 5± 2 3 1) %、(341 1±4 2 6 )ng/L、(5 7 3± 19 2 ) ,显著高于对照组的 (2 2 0± 1 5 0 ) %、(1 8± 0 9) %、(0 3± 0 1)mg/L、(99 8± 2 2 8) %、(5 3 7± 16 8)ng/L、(3 4± 1 5 ) ,两组相比差异有显著性 (P均 <0 0 1) ;而 6 Keto PGF1α为(6 7± 2 8)ng/L ,显著低于对照组的 (16 8± 2 6 )ng/L ,差异有显著性 (P <0 0 1)。ACA IgG、IgA显著高于对照组 (P <0 0 1)。PTE患者经治疗 1周后 6 Keto PGF1α较治疗前明显升高 (P <0

Changes of the platelet function and serum anticardiolipin antibody in patients with pulmonary thromboembolism

OBJECTIVE: To explore the changes of the platelet function and serum anticardiolipin antibody (ACA) in patients with pulmonary thromboembolism (PTE). METHODS: Forty-eight patients with PTE diagnosed by spiral computed tomographic pulmonary angiography (CTPA) were included as the trial group, while 20 person in which PTE was excluded served as the control group. P-selectin, and GPIIb/IIIa expressed on platelets were measured by flow cytometry, and plasma TXB(2), 6-Keto-PGF1alpha, vWF, D-dimer and serum ACA were measured by ELISA and the changes of these parameters were compared 1 week later. RESULTS: In the trial group, the levels of P-selectin, GPIIb/IIIa, TXB(2), vWF, D-dimer and T/K were significantly higher than those in the control group (P < 0.01). But the plasma level of 6-Keto-PGF1alpha in the patients with PTE was significantly lower than that in the control group (P < 0.01). The levels of ACA-IgG and ACA-IgA were significantly higher than those in the control group (P < 0.01). After therapy the level of 6-Keto-PGF1alpha was significantly higher than that before therapy (P < 0.01), and other parameters were significantly lower than those before therapy (P < 0.01). P-selectin, GPIIb/IIIa and vWF were positively correlated with D-dimer (P < 0.01). CONCLUSION: Endothelium damage, platelet activation and hypercoagulation combined with fibrinolytic activation occur in patients with PTE.