内皮素-1、脂蛋白a及同型半胱氨酸对肺栓塞早期诊断的应用价值

目的：通过家兔肺血栓栓塞症（PTE）模型检测血浆中内皮素-1，同型半胱氨酸和血清脂蛋白a水平，并探讨它们对早期诊断PTE的价值，方法：家兔30只随机分为对照组和PTE模型组，每组15只，通过颈静脉注入自体血凝块，建立家兔急性PTE模型，分别于栓塞前及栓塞后不同时段采静脉血，采用酶联免疫吸附法和放射免疫分析法动态观察血浆中内皮素-1、同型半胱氨酸和血清中脂蛋白a水平，同时作肺脏解剖及病理研究PTE后血栓形成及其分布规律．结果：解剖肺脏可见肺动脉内血栓栓塞、暗红色梗死灶及出血点；光镜下可见血栓附着处有内膜细胞长入血栓表面，血管内皮增生，炎细胞浸润，血浆内皮素-1于栓塞后1h开始升高，与对照组比较有显著性差异（P〈0.05），栓塞后24h脂蛋白a及同型半胱氨酸开始升高，与对照组比较有显著性差异（P〈0．05）．结论：内皮素-1，脂蛋白a和同型半胱氨酸参与了急性PTE的早期发病过程，联合检测对PTE具有重要诊断价值，可以作为早期诊断筛选PTE的血清学标志物.

Value of endothelin-1, homocysteine and lipoprotein a for early diagnosis of pulmonary thromboembolism

AIM: To study the changes of plasma endothelin-1 (ET-1), homocysteine (Hcy) and serum lipoprotein a (LPa) before and after pulmonary thromboembolism (PTE) in rabbits and to evaluate their values as serologic markers for early diagnosis of PTE. METHODS: Thirty rabbits were divided randomly into 2 groups: the control group and the PTE group, with 15 rabbits in each group. Rabbit PTE models were established by injection of auto-blood clots into the jugular vein. The changes of the contents of ET-1, Hcy in plasma and LPa in serum were measured at different time points before and after PTE. The formation and distribution of thrombosis were observed at pulmonary dissection under microscopy after PTE. RESULTS: The injected blood clots were found in the pulmonary arteries and the hemorrhagic infarct and bleeding points were observed in the PTE group. Growth of endomembrane cells into the surface of the thrombosis, endotheliosis and inflammatory cell infiltration were observed by microscopy. The concentration of plasma ET-1 in PTE group increased significantly from 1h after PTE compared with that in control group (P<0.05). The concentration of LPa and Hcy in blood were significantly elevated 24h after PTE (P<0.05). CONCLUSION: ET-1, LPa and Hcy are involved in the early phase of PTE and can be used as serologic markers for early diagnosis of PTE.