静脉血栓栓塞症患者活化蛋白C抗性及凝血因子V活性和基因多态性研究

本研究旨在观察静脉血栓栓塞患者凝血因子V(Factor V,F V)活性改变,检测活化蛋白C抗性(activated protein C resistance,APCR)和凝血因子V基因F V Leiden、F V Cambridge、F V Hong Kong、F V Asp79His和F V I359T多态性.对95例静脉血栓栓塞患者(其中下肢深静脉血栓79例,肺栓塞4例,下肢深静脉血栓合并肺栓塞12例)和95例正常对照者.应用限制性内切酶片段长度多态性测定FV Leiden、F V Cambridge和F V Hong Kong多态性,用MassARRAYTM技术检测F V Asp79His、F V I359T多态性.以一期法和校正的APTT试验分别对其中的65例静脉血栓栓塞患者和60例正常对照者行凝血因子V活性水平和活化蛋白C抵抗检测.结果表明静脉血栓栓塞患者血浆凝血因子V活性水平(108.03%±28.29%)高于对照组(95.17%±29.75%),差异有显著性统计学意义(P=0.008);静脉血栓栓塞组活化蛋白C抵抗阳性13例(20.0%),对照组3例(5.0%),二组比较,有统计学意义(P=0.012).二组均未发现FV Leiden、F V Cambridge、F V Hong Kong、FV Asp79His和FV I359T多态性.结论凝血因子V活性升高和活化蛋白C抵抗是静脉血栓栓塞的危险因素,但APCR与F V Leiden、F V Cambridge、F V HongKong、F V Asp79His和F V I359T多态性无关.

Analysis of Activated Protein C Resistance,Factor V Coagulation Activity and Gene Polymorphisms in Patients with Venous Thromboembolism

The study was aimed to investigate the factor V coagulation activity (FV:C), and to evaluate FVgene polymorphisms and activated protein C resistance (APCR) in the patients with venous thromboembolism (VTE). 95 patients with VTE and 95 normal controls were investigated for FV gene polymorphisms. FV Leiden, FVCambridge, and FVHong Kong were detected by PCR, MnlI and BstNI digestion respectively. FVAsp79His and FVI359T were detected by MassARRAY. FV:C and APCR in 65 patients with VTE and 60 normal controls were determined by a one-stage clotting method and the APTT-based assays respectively. The results showed that the mean levels of plasma FV:C were significantly higher in VTE group than that in controls (108.03% +/- 28.29% vs 95.17% +/- 29.75%) (P = 0.008), the incidence of APCR were 20.0% (13 of 65 cases) in patients with VTE and 5.0% (3 of 60 cases) in normal controls (P = 0.012). FV Leiden, FVCambridge, FVHong Kong, FVAsp79His and FVI359T mutations were not found in two groups. It is concluded that the increased plasma level of FV:C is a risk factor for VTE. There is APCR in both groups, APCR is also a risk factor to VTE. APCR may not be associated with mutations of FV Leiden, FVCambridge, FVHong Kong, FVAsp79His and FV I359T polymorphisms, other factors need to study further in APCR.