心脏机械膜瓣置换术后血浆蛋白C和蛋白S活性变化及其与INR的关系

目的:探讨机械瓣膜置换术后口服华法令抗凝的患者血浆蛋白C(PC)、蛋白S(PS)活性改变的意义及其与国际标准IL比值(INR)的关系。方法:动态监测15例心脏机械瓣膜置换术后口服抗凝药初期患者服药1-2 d、3~10 d及1个月的PC、PS活性及INR值。结果:患者组PC、PS活性低于正常对照组(P<0.05),特别是术后3-10 d PC、PS活性明显低于正常对照组(P<0.01),已下降到正常的50％左右,而此时INR尚未达到治疗范围,提示口服抗凝药治疗初期在人体凝血功能未下调时,抗凝系统功能已经开始下降,有发生血栓的倾向;并且,随着抗凝强度的增高(INR低于1.5-高于2.5),PC、PS活性明显下降。结论:口服华法令抗凝患者在监测INR的同时,需要进行血浆PC、PS活性监测,以更好地预防血栓的发生。

The Chang of Protein C and Protein S Following Mechanical Heart Vale Replacement and the Relation with INR

Objective:To study the change of activity of plasma protein C (PC)and protein S (PS) in patients following mechanical heart valve replacement treated with warfarin and relation with INR. Methods: The activity of PC,PS and INR were measured in 15 patients in the stage of initial anticoagulant. The patients were divided to three groups medicining 1 - 2 day group, 3 - 10 day group , a month group. Results: The activity of PC, PS in patients groups were lower than normal control group ( P < 0.05) especially 3-10 day group, the activity of PC,PS were obvious lower than normal control group ( P < 0.01) . They have reduced to about 50% of normal control lever, however the INR has not come to the lever of effecting. It means the patients in the stage of initial anticoagnla-tion ,when the coagnlation system s faction have not descended, the anticoagnlaeion system s fuceion has descended . There is the tendency to occur thrombosis and the activity of PC, PS sharply decreased along with the high of anticoagulant intensity(INR < 1.5 - > 2.5) . Conclusion:The patients after mechanical valve replacement treated with warfarin should be periodic checked-up the activity of PC and PS, in order to prevent the happens of thrombosis.