CAJ | 학술논문

目的：观察血浆血栓前状态分子标志物水平在围手术期的动态变化规律，筛选早期识别深静脉血栓形成的特异性、敏感性高的监测指标。方法选择在我院择期行股骨骨折内固定或股骨头置换术患者76例为试验组，20名健康体检者为对照组。采用免疫比浊法、酶联免疫吸附试验（ELISA）分别检测术前，术后1、3、5、7 d 机体凝血酶原时间（PT）、部分活化凝血酶原时间（APTT）、D-二聚体（D-D）、α颗粒膜蛋白140（GMP-140）、血管性血友病因子（vWF）、血栓前体蛋白（TpP）、纤维蛋白原（FIB）含量、人抗凝血酶-Ⅲ（AT-Ⅲ）、血浆组织型纤溶酶原激活剂（t-PA）、组织因子（TF）水平。结果同对照组比较，试验组患者术前 PT、APTT、GMP-140、TpP、AT-Ⅲ、FIB、 t-PA 无明显变化，差异无统计学意义（P＞0.05），D-D、vWF、TF 同对照组比较明显升高，差异有统计学意义（P<0.05）。同手术前比较，D-D、GMP-140、TpP、FIB、TF、t-PA 明显升高，差异有统计学意义（P<0.05）。 AT-Ⅲ较术前明显降低，差异有统计学意义（P<0.05）。结论①围术期患者机体处于高凝状态（血栓前状态），有利于深静脉血栓形成。机体凝血活性增强、抗凝及纤溶活性减弱共同形成了术后高凝状态的病理学基础。②GMP-140、vWF、AT-Ⅲ、D-D、FIB 是反映血栓前状态的可靠指标。这些指标的动态变化对早期发现围手术期患者是否处于血栓前状态，针对性采取深静脉血栓预防措施有重要的指导意义。
목적：관찰혈장혈전전상태분자표지물수평재위수술기적동태변화규률，사선조기식별심정맥혈전형성적특이성、민감성고적감측지표。방법선택재아원택기행고골골절내고정혹고골두치환술환자76례위시험조，20명건강체검자위대조조。채용면역비탁법、매련면역흡부시험（ELISA）분별검측술전，술후1、3、5、7 d 궤체응혈매원시간（PT）、부분활화응혈매원시간（APTT）、D-이취체（D-D）、α과립막단백140（GMP-140）、혈관성혈우병인자（vWF）、혈전전체단백（TpP）、섬유단백원（FIB）함량、인항응혈매-Ⅲ（AT-Ⅲ）、혈장조직형섬용매원격활제（t-PA）、조직인자（TF）수평。결과동대조조비교，시험조환자술전 PT、APTT、GMP-140、TpP、AT-Ⅲ、FIB、 t-PA 무명현변화，차이무통계학의의（P＞0.05），D-D、vWF、TF 동대조조비교명현승고，차이유통계학의의（P<0.05）。동수술전비교，D-D、GMP-140、TpP、FIB、TF、t-PA 명현승고，차이유통계학의의（P<0.05）。 AT-Ⅲ교술전명현강저，차이유통계학의의（P<0.05）。결론①위술기환자궤체처우고응상태（혈전전상태），유리우심정맥혈전형성。궤체응혈활성증강、항응급섬용활성감약공동형성료술후고응상태적병이학기출。②GMP-140、vWF、AT-Ⅲ、D-D、FIB 시반영혈전전상태적가고지표。저사지표적동태변화대조기발현위수술기환자시부처우혈전전상태，침대성채취심정맥혈전예방조시유중요적지도의의。
Objective To examine the dynamic change patterns of molecular markers of plasma pre-thrombotic state during perioperation period, and to idenitfy the monitoring index with high specificity and sensitivity in early-stage deep vein thrombosis. Methods Seventy-six patients scheduling for selective operation of internal fixation of femoral fracture or replacement of femoral neck were recruited in our hospital (experiment group), and 20 healthy subjects were enrolled as the control group. The levels of prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimmer (D-D), α granule membrane protein 140 (GMP-140), von Willebrand factor (vWF), thrombus pre-cursor protein (TpP), fibrinogen (FIB) content, human anti-thrombin receptor-Ⅲ (AT-Ⅲ), plasma tectotype plasmino-gen activatior (t-PA), and tissue factor (TF), were detected before and at days 1, 3, 5 and 7 of the operation by using immunoturbidimetry (ITM) assay and enzyme-linked immunosorbent assay. Results Compared with the control group, the levels of PT, APTT, GMP-140, TpP, AT-Ⅲ, FIB, t-PA did not differ significantly at pre-operation period in the ex-periment group (all P>0.05). The levels of D-D, vWF and TF at pre-operation period were significantly increased in the experiment group compared with the control group (all P<0.05). The levels of D-D, GMP-140, TpP, FIB, TF, and t-PA were significantly increased (all P<0.05) and the level of AT-Ⅲ was significantly decreased (all P<0.05) after op-eration compared with those of pre-operation period in the experiment group (all P<0.05). Conclusion Deep venous thrombosis is readily formed during the perioperative period (pre-thrombotic state). The increased clotting activity, de-creased anticoagulation activity and reduced fibrinolytic activity lead to the pathologic basis of hypercoagulable state postoperatively. GMP-140, vWF, AT-Ⅲ, D-D, FIB are the reliable indices to reflect the pre-thrombotic state, the dy-namic change of which plays an important role in the early diagnosis of prethrombotic state and deep venous thrombo-sis precaution during the perioperative period.