血浆血栓素A2/前列腺素I2值与骨骼肌无复流现象

背景：在骨骼肌无复流现象中血栓素A2及前列腺素I2是重要参与因子。 目的：观察下肢动脉栓塞患者血浆血栓素A2/前列腺素I2值与骨骼肌发生无复流现象的关系。 方法：选择经影像学及临床表现确诊为下肢动脉栓塞患者36例,行下肢动脉取栓,根据患者取栓后缺血肢体是否发生无复流现象分为无复流组(n=10)和对照组(n=26)。 结果与结论：与对照组比较,无复流组取栓后0 h无复流组前列腺素I2明显减少(P < 0.01);取栓后24 h,无复流组血栓素A2明显升高、前列腺素I2明显下降(P < 0.01)。与对照组相比,无复流组术后血栓素A2/前列腺素I2值升高(P < 0.05)。与术前相比,对照组术后血栓素A2/前列腺素I2值升高后然后下降,无复流组取栓后均维持较高的水平。而取栓前后两组血小板数量及血浆纤维蛋白原的水平差异均无显著性意义。同时术后24 h点无复流组血栓素A2/前列腺素I2值与纤维蛋白原呈正相关(r=0.613, P=0.049);而与血小板数量无相关性(r=0.199,P=0.543)。提示血栓素A2/前列腺素I2值可以作为判断动脉栓塞患者缺血再灌注后骨骼肌发生无复流现象的指标之一。

Relationship between plasma thromboxane A2/prostaglandin I2 value and no-reflow phenomenon in acute limb arterial embolism patients

BACKGROUND:Microcirculation disturbance plays an important role in the no-reflow phenomenon in skeletal muscle, thromboxane A2 (TXA2) and prostaglandin I2 (PGI2) are the important factors to ensure microcirculation balance. OBJECTIVE:To investigate the relationships between plasma TXA2/PGI2 value and the no-reflow phenomenon in skeletal muscle. METHODS:Thirty-six patients with lower extremity arterial thrombosis confirmed by imaging results and clinical manifestations were included in this study. After embolectomy, the patients were assigned to two groups according to whether reflow existed in ischemic limbs: no-reflow (n=10) and control (n=26). RESULTS AND CONCLUSION: Compared with control group, PGI2 level was significantly decreased at 0 hour after embolectomy (P < 0.01), and at 24 hours after embolectomy, TXA2 level was significantly increased and PGI2 level was significantly decreased (P < 0.01), in the no-reflow group. Compared with control group, TXA2/PGI2 value in the no-reflow group was significantly increased (P < 0.05). The TXA2/PGI2 value in the control group increased and then decreased after embolectomy, while the TXA2/PGI2 value in the no-reflow group maintained at a very high level. Prior to and after embolectomy, there was no significant difference in blood platelet amount and plasma fibrinogen level between no-reflow and control groups. At 24 hours after embolectomy, the TXA2/PGI2 value in the no-reflow group was positively correlated with plasma fibrinogen level (r=0.613, P=0.049), but it was not correlated with blood platelet amount (r=0.199, P=0.543). These findings suggest that TXA2/PGI2 value can be used as one of indexes for judging no-reflow phenomenon in skeletal muscle of acute arterial embolism patients.