慢性心力衰竭患者凝血功能及C反应蛋白的改变

目的:研究慢性心力衰竭(心衰)患者中血浆组织因子(tissue factor,TF)活性、组织因子途径抑制物(tissue factor pathway inhibitor,TFPI)活性、血浆纤维蛋白原(Fibrinogen,Fg)等高凝状态指标,以及高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP),探讨慢性心衰患者中凝血系统激活状态以及炎症反应。方法:采用发色底物法分别测定慢性心衰患者(心衰患者根据是否有心房颤动分为两组:心衰1组为无心房颤动者,心衰2组为合并有心房颤动者)、心功能正常的心脏病患者(心脏病心功能正常组)和正常人(正常对照组)血浆TF活性和TFPI活性。用酶联免疫吸附法测定血浆D-二聚体、用全自动血凝分析仪测定血浆Fg、用免疫浊度法测定hs-CRP。结果:慢性心衰患者各组TF活性、TFPI活性、D-二聚体、Fg水平显著高于心脏病心功能正常组及正常对照组(P< 0．05-0．01)。慢性心衰患者各组中hs-CRP也显著高于心脏病心功能正常组及正常对照组(P<0．01)。心衰1组和心衰2组之间TF活性、TFPI活性、D-二聚体、Fg、hs-CRP的差异无显著性(P>0．05)。相关性分析显示心衰患者中TF活性与LVEF负相关(r=-0．38,P<0．05),Fg水平与hs-CRP正相关(r=0．37,P<0．05)。结论:慢性心衰患者中存在凝血系统的激活,TF促凝活性明显增加,存在明显的高凝状态,并且左心室收缩功能越低的患者中TF促凝活性越高。慢性心衰患者中hs-CRP显著升高提示心衰中存在炎症反应,并且与高凝状态有一定的关联。

Coagulation Function and C-reactive Protein Change in Patients With Chronic Heart Failure

Objective:To investigate homeostatic function,especially for the role of tissue factor(TF) and tissue factor pathway inhibitor (TFPI),and high-sensitivity C-reactive protein(hs-CRP) as inflammatory biomarkers and their clinical significance in patients with heart failure. Methods:Thirty-eight patients with chronic heart failure were assigned to group 1 (without a trial fibrillationn,n =20) or group 2 (with atrial fibrillationn, n = 18). There were two age and sex matched control groups: one was in sinus rhythm with cardiovascular disease and normal heart function(n=20),the other induoling healthy subjects(n =20). The plasma TF activity and TFPI activity were analyzed with chromogenic assay. The plasma fibrin D-dimer was measured using enzyme linked immunoassay. Fibrinogen(Fg) and hs-CRP were measured. Results:Compared with the healthy control group and the normal heart function group,patients with heart failure had higher levels of TF activity, TFPI activity, D-dimer,Fg,and hs-CRP(P<0.05). There were no significant differences in the levels of TF activity and TFPI activity,D-dimer,Fg and hs-CRP between group 1 and group 2(P>0.05). In the heart failure patients,level of TF activity was negatively related to that of LVEF(P<0.05) , and the level of Fg was positively related to that of hs-CRP(P<0.05). Conclusion: Patients with heart failure showed evidence of hypercoagulability. Increased plasma hs-CRP suggests that there is an inflammatory lesion,which may correlated with for hypercoagulability.