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低氧性肺动脉高压患者凝血纤溶因子和血细胞比容的变化及其意义

Changes and significance of coagulation-fibrinolysis factors and hematocrit in patients with hypoxic pulmonary hypertension
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摘要 目的观察低氧性肺动脉高压(HPH)患者凝血纤溶因子、血细胞比容(HCT)的变化情况及与动脉血气分析、肺动脉收缩压(PASP)的相关性,旨在探讨凝血纤溶因子和HCT在HPH诊治中的临床意义。方法2017年11月至2018年11月入选明确诊断的31例HPH患者为HPH组,入选同期34例健康体检者为对照组。对入选者检测凝血纤溶因子[血管性血友病因子(vWF)、蛋白C、组织型纤溶酶原激活剂(t-PA)和纤溶酶原活化剂抑制剂-1(PAI-1)]、HCT和动脉血气[二氧化碳分压(PaCO2)、氧分压(PaO2)]分析,并测量PASP。结果HPH组患者血浆vWF、t-PA、PAI-1、HCT和PaCO2水平均显著高于对照组,HPH组患者血浆蛋白C、PaO2水平均显著低于对照组,差异均有统计学意义(P<0.01)。HPH组患者t-PA/PAI-1的比值显著低于对照组[(0.132±0.006)vs(0.160±0.018),t=8.041,P=0.000]。vWF、PAI-1、HCT与PaO2均呈负相关(r=-0.395、-0.317、-0.522,P<0.05或P<0.01);vWF、PAI-1、HCT与PaCO2均呈正相关(r=0.504、0.377、0.642,P<0.05或P<0.01);vWF、PAI-1、HCT与PASP均呈正相关(r=0.796、0.547、0.666,P<0.01)。PaCO2与PASP呈正相关(r=0.622,P<0.05),PaO2与PASP呈负相关(r=-0.626,P<0.05)。结论HPH患者存在明显的凝血纤溶功能失衡,其中血浆vWF、PAI-1和HCT水平可作为预测HPH患者肺动脉高压严重程度的指标。检测凝血纤溶因子和HCT水平的变化对HPH患者的病情判断及指导临床采取抗凝等治疗措施有重要意义。 Objective To observe the changes of coagulation-fibrinolysis factors and hematocrit (HCT) in patients with hypoxic pulmonary hypertension (HPH) and their associations with arterial blood gas analysis and pulmonary artery systolic pressure (PASP) so as to explore the clinical significance of coagulation-fibrinolysis factors and HCT in the diagnosis and treatment of HPH.Methods From November 2017 to November 2018,31 HPH patients diagnosed definitely were enrolled (HPH group),and 34 healthy persons were served as control group.Coagulation-fibrinolysis factors [von Willebrand factor (vWF),protein C (PC),plasminogen activator inhibitor-1 (PAI-1),tissue plasminogen activator (t-PA)],HCT and arterial blood gas analysis [partial pressure of carbon dioxide (PaCO2 ),partial oxygen pressure (PaO2 )]were detected, and PASP was measured in two groups.Results (1) The levels of vWF,PAI-1,t-PA,HCT and PaCO2 in HPH group were significantly higher than those in control group (P < 0.01),and the levels of PC and PaO2 were significantly lower than those in control group (P < 0.01).(2) Compared with control group,the ratio of t-PA /PAI-1 decreased significantly in HPH group (0.132 ± 0.006 vs 0.160 ± 0.018,t = 8.041,P = 0.000).(3) vWF,PAI-1,HCT were negatively correlated with PaO2 (r =-0.395,r =-0.317,r =-0.522,P < 0.05 or P < 0.01) and were positively correlated with PaCO2 (r = 0.504,r = 0.377,r = 0.642,P < 0.05 or P < 0.01) and PASP (r = 0.796,r = 0.547,r = 0.666,P < 0.01).PaCO2 was positively correlated with PASP(r = 0.622,P < 0.05),and PaO2 was negatively correlated with PASP(r =-0.626,P < 0.05).Conclusions The plasma levels of vWF,PAI-1 and HCT can be used as indicators to predict the severity of pulmonary hypertension in HPH patients with significant imbalance between coagulation and fibrinolysis.The detection of coagulation and fibrinolysis levels and HCT is of great significance for judging the condition of HPH patients and guiding clinical treatment of anticoagulation.
作者 李宜珊 康睿男 张舒婷 李杰娜 施熠炜 LI Yi-shan;KANG Rui-nan;ZHANG Shu-ting;LI Jie-na;SHI Yi-wei(Department of Respiratory and Critical Care Medicine,the First Hospital of Shanxi Medical University,Taiyuan,Shanxi 030001,China)
出处 《中国临床研究》 CAS 2019年第8期1045-1048,共4页 Chinese Journal of Clinical Research
关键词 肺动脉高压 低氧性 血细胞比容 肺动脉收缩压 二氧化碳分压 血管性血友病因子 纤溶酶原活化剂抑制剂-1 组织型纤溶酶原激活剂 Pulmonary hypertension,hypoxic Hematocrit Pulmonary artery systolic pressure Partial pressure ofcarbon dioxide von Willebrand factor Plasminogen activator inhibitor-1 Tissue plasminogen activator
作者简介 通讯作者:施熠炜,E-mail:chinasyw225@163.com.
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