低分子肝素对下肢骨科手术后患者von Willebrand因子和α颗粒膜蛋白140的干预作用

目的探讨低分子肝素对下肢骨科手术患者血浆vonWillebrand因子（VWF）和α颗粒膜蛋白140（GMP-140）的干预作用及其机制。方法将50例下肢骨科手术患者分为治疗组和对照组，每组各25例。两组患者均接受相同的骨科治疗和护理措施，不同的是治疗组患者术前12h和术后每天一次接受皮下注射低分子肝素钙，共11d，而对照组以等量生理盐水皮下注射。检测术前和术后第1、7和14天患者血浆VWF和GMP-140水平，术后第7天和第14天彩色多普勒超声检测双下肢血管判断是否形成下肢深静脉血栓（DVT）。结果治疗组和对照组相比，术前血浆VWF和GMP-140含量的比较，差异均无统计学意义（P均〉0．05）；术后第1天治疗组血浆VWF和GMP-140略低于对照组，但差异均无统计学意义（P均〉0．05）。术后第7天和第14天治疗组VWF均明显低于对照组（t=13．126、9．163，P均〈0．01；t=11．785、8．291，P均〈0．05）。两组在观察期内均未发现有DVT。结论低分子肝素可降低下肢骨科手术后患者血浆VWF和GMP-140水平，减轻血管内皮细胞损害，并降低DVT的发生风险。

Effect of low molecular weight heparin on the von Willebrand factor and platelet alpha-granule membrane protein-140 in patients with lower limb orthopedic surgery

Objective To investigate the effect and mechanism of low molecular weight heparin on the von willebrand factor(VWF) and the platelet alpha-granule membrane protein-140(GMP-140) in patients with lower limb orthopedic surgery.Methods Fifty patients undergoing lower limb orthopedic surgery were randomly divided into the treatment group(25 cases) and the control group(25 cases).The patients in the treatment group received low molecular weight heparin calcium by hypodermic injection at 12 h before surgery and once daily for 11 d after surgery,while in the control group patients received equivalent amount of normal saline instead.The levels of VWF and GMP-140 were tested before and on days 1,7,and 14 after surgery,and deep venous thrombosis(DVT) was detected by color doppler ultrasonography on 7th and 14th d.Results There were no statisticaldifferences in the levels of VWF and GMP-140 before the surgery(all P > 0.05).After the surgery,the levels of VWF and GMP-140 in the treatment group were significantly lower on 7th and 14th d(t = 13.126,9.163,all P < 0.01;t = 11.785,8.291,all P < 0.05),while showed no statistical differences on 1st d when compared to those in the control group(all P > 0.05).All patients in the two groups did not find DVT on 7th and 14th d after surgery.Conclusion The LMWH in patients with lower limb orthopedic surgery could decrease the levels of VWF and GMP-140,reduce the endothelial cell damage and the risk of DVT.