溃疡性结肠炎发病中凝血功能变化的研究
发布时间：2019-06-26 11:06
【摘要】：溃疡性结肠炎(ulcerative colitis,UC)是一种病因和发病机制尚不明确的慢性非特异性炎症,以反复发作的腹痛、腹泻、粘液脓血便为主要临床表现。近年来,研究发现UC患者常处于高凝状态,易并发血栓栓塞性疾病,且多为无症状性血栓,对UC患者存在潜在的威胁,血栓栓塞已成为导致溃疡性结肠炎患者死亡的原因之一,越来越引起人们的关注。溃疡性结肠炎血栓形成的机制非常复杂,目前尚未明确,多数研究认为UC患者高凝状态、血栓栓塞的发展通过影响其凝血机制而实现,是获得性和遗传性风险因素之间相互作用的结果,UC患者凝血功能紊乱主要包括血小板功能障碍、内皮细胞受损、凝血系统异常、纤溶系统受破坏和免疫功能异常等系统变化,这些风险因素在血栓形成之前已发生相关变化。因此,对UC患者凝血功能相关指标进行有效监测,通过加强对住院患者或存在血栓风险病人的管理,可改善UC患者的高凝状态,有效预防血栓的发生,降低病死率,提高患者生活质量,为UC治疗提供新的临床思路和研究方向。凝血功能相关指标在UC发病机制及并发血栓栓塞风险中的作用尚未明确,有待进一步试验研究阐明。本实验探讨UC患者血小板计数、平均血小板体积、P-选择素表达、同型半胱氨酸、凝血因子Ⅴ、凝血因子Ⅷ、D-二聚体、抗心磷脂抗体水平变化。目的:检测UC患者凝血功能相关指标的变化,探讨其是否与UC患者高凝状态及UC严重程度相关。方法:1选取2016年1月至2017年1月在河北医科大学第二医院确诊为UC活动期患者29例作为实验组,并按照改良Mayo评分将其分为轻度、中度、重度三组,轻度10例、中度7例、重度12例。结肠息肉患者11例作为对照组。2检测实验组及对照组外周血血小板计数、平均血小板体积、P-选择素表达、同型半胱氨酸、凝血因子Ⅴ、凝血因子Ⅷ、D-二聚体、抗心磷脂抗体水平。应用SPSS13.0采用方差分析对数据进行统计学分析。3结肠镜下选取直-乙交界处结肠黏膜2块,采用HE染色显微镜下观察结肠粘膜组织病理学表现,免疫组化方法检测结肠粘膜P-选择素表达情况。应用SPSS21.0采用χ2检验对数据进行统计学分析。结果:1外周血结果UC患者PLT计数、P-选择素、同型半胱氨酸、凝血因子Ⅷ、D-二聚体显著高于对照组(P0.05),差异有统计学意义;平均血小板体积(mean platelet volume,MPV)、凝血因子Ⅴ显著低于对照组(P0.05),差异有统计学意义;抗心磷脂抗体(anticardiolipin antibody,ACA)阳性率显著高于对照组。PLT计数为重度中度轻度对照组,任意两组比较,差异有统计学意义(P0.05);同型半胱氨酸水平为重度显著高于轻度和中度(P0.05);凝血因子Ⅷ水平为重度显著高于轻度(P0.05);D-二聚体水平为重度和中度显著高于轻度(P0.05);P-选择素、MPV、凝血因子Ⅴ水平任意两组间比较,差异无统计学意义(P0.05);2 HE染色结果对照组结肠黏膜上皮结构完整,腺体细胞排列整齐,杯状细胞较多,可见少量炎性细胞浸润;UC各组黏膜上皮脱落或缺失,可见大量炎性细胞浸润,腺体变形、排列紊乱、数目减少,隐窝结构紊乱,隐窝内及隐窝上皮均可见大量中性粒细胞浸润,伴杯状细胞减少;3免疫组织化学染色检测结肠粘膜组织中p-选择素的表达UC患者结肠粘膜中P-选择素表达较对照组增加,具有统计学意义(P0.05),P-选择素阳性染色率重度83.33%(10/12)中度57.14%(4/7)轻度30%(3/10),各组之间差别有统计学意义(P0.05)。结论:1活动期UC患者处于高凝状态,存在凝血功能紊乱,主要与血小板功能障碍、内皮细胞受损、凝血系统异常、纤溶系统受破坏和免疫功能异常相关。2活动期UC患者PLT计数、P-选择素、同型半胱氨酸、凝血因子Ⅷ、D-二聚体明显升高,凝血因子Ⅴ、MPV明显降低,ACA阳性率增加,对监测机体高凝状态具有重要作用,是预防血栓形成的有效临床指标。3活动期UC患者PLT计数、结肠粘膜组织中P-选择素表达与疾病严重程度相关。
[Abstract]:Ulcerative colitis (UC) is a kind of chronic non-specific inflammation which is not clear in the pathogenesis and pathogenesis, and is the main clinical manifestation of recurrent abdominal pain, diarrhea, and mucus. In recent years, it has been found that UC patients are often in hypercoagulable state, easy to be concurrent with thromboembolic diseases, and are not asymptomatic, and there is a potential threat to UC patients. Thromboembolism has become one of the causes leading to the death of patients with ulcerative colitis, and more and more attention has been paid to. The mechanism of the formation of ulcerative colitis is very complex and is not yet clear, most of which are considered to be hypercoagulable in patients with UC, and the development of thromboembolism is achieved by influencing its clotting mechanism, as a result of the interaction between acquired and inherited risk factors, Coagulation dysfunction in patients with UC mainly includes such system changes as platelet dysfunction, impaired endothelial cell, abnormal blood coagulation system, disruption of the fibrinolytic system and abnormal immune function, and these risk factors have changed before the formation of the thrombus. Therefore, the blood coagulation function related index of the UC patient is effectively monitored, the high-setting state of the UC patient can be improved, the occurrence of the thrombus is effectively prevented, the fatality rate is reduced, the quality of life of the patient is improved, And provides a new clinical thought and a research direction for the treatment of UC. The role of coagulation-related index in the pathogenesis of UC and the risk of concurrent thromboembolic events is not clear, and the study is to be further tested and clarified. The platelet count, mean platelet volume, P-selectin expression, homocysteine, coagulation factor V, factor VIII, D-dimer and anticardiolipin antibody level were discussed in this experiment. Objective: To investigate the changes of coagulation function in patients with UC and to explore whether it is related to the hypercoagulability and the severity of UC in patients with UC. Methods: From January 2016 to January 2017,29 patients with active UC were identified as experimental group and the modified Mayo score was divided into mild, moderate, severe three groups, mild in 10, moderate in 7, and severe in 12 cases. The peripheral blood platelet count, mean platelet volume, P-selectin expression, homocysteine, coagulation factor V, factor VIII, D-dimer and anticardiolipin antibody level in the peripheral blood of the experimental group and the control group were measured. The data were analyzed by means of analysis of variance with SPSS 13.0. Two blocks of colon mucosa at the junction of straight-B were selected under the colonoscope. The pathological manifestations of the colonic mucosa were observed by HE staining. The expression of P-selectin in the colon mucosa was detected by immunohistochemistry. Statistical analysis of the data was performed using the SPSS21.0 using the Sup2 test. Results: The level of PLT, P-selectin, homocysteine, factor VIII and D-dimer in peripheral blood of patients with UC were significantly higher than that in the control group (P0.05). The mean platelet volume (MPV) and coagulation factor V were significantly lower than that in the control group (P0.05). The positive rate of anticardiolipin antibody (ACA) was significantly higher than that of the control group. The level of blood coagulation factor 鈪，
本文编号：2506136
[Abstract]:Ulcerative colitis (UC) is a kind of chronic non-specific inflammation which is not clear in the pathogenesis and pathogenesis, and is the main clinical manifestation of recurrent abdominal pain, diarrhea, and mucus. In recent years, it has been found that UC patients are often in hypercoagulable state, easy to be concurrent with thromboembolic diseases, and are not asymptomatic, and there is a potential threat to UC patients. Thromboembolism has become one of the causes leading to the death of patients with ulcerative colitis, and more and more attention has been paid to. The mechanism of the formation of ulcerative colitis is very complex and is not yet clear, most of which are considered to be hypercoagulable in patients with UC, and the development of thromboembolism is achieved by influencing its clotting mechanism, as a result of the interaction between acquired and inherited risk factors, Coagulation dysfunction in patients with UC mainly includes such system changes as platelet dysfunction, impaired endothelial cell, abnormal blood coagulation system, disruption of the fibrinolytic system and abnormal immune function, and these risk factors have changed before the formation of the thrombus. Therefore, the blood coagulation function related index of the UC patient is effectively monitored, the high-setting state of the UC patient can be improved, the occurrence of the thrombus is effectively prevented, the fatality rate is reduced, the quality of life of the patient is improved, And provides a new clinical thought and a research direction for the treatment of UC. The role of coagulation-related index in the pathogenesis of UC and the risk of concurrent thromboembolic events is not clear, and the study is to be further tested and clarified. The platelet count, mean platelet volume, P-selectin expression, homocysteine, coagulation factor V, factor VIII, D-dimer and anticardiolipin antibody level were discussed in this experiment. Objective: To investigate the changes of coagulation function in patients with UC and to explore whether it is related to the hypercoagulability and the severity of UC in patients with UC. Methods: From January 2016 to January 2017,29 patients with active UC were identified as experimental group and the modified Mayo score was divided into mild, moderate, severe three groups, mild in 10, moderate in 7, and severe in 12 cases. The peripheral blood platelet count, mean platelet volume, P-selectin expression, homocysteine, coagulation factor V, factor VIII, D-dimer and anticardiolipin antibody level in the peripheral blood of the experimental group and the control group were measured. The data were analyzed by means of analysis of variance with SPSS 13.0. Two blocks of colon mucosa at the junction of straight-B were selected under the colonoscope. The pathological manifestations of the colonic mucosa were observed by HE staining. The expression of P-selectin in the colon mucosa was detected by immunohistochemistry. Statistical analysis of the data was performed using the SPSS21.0 using the Sup2 test. Results: The level of PLT, P-selectin, homocysteine, factor VIII and D-dimer in peripheral blood of patients with UC were significantly higher than that in the control group (P0.05). The mean platelet volume (MPV) and coagulation factor V were significantly lower than that in the control group (P0.05). The positive rate of anticardiolipin antibody (ACA) was significantly higher than that of the control group. The level of blood coagulation factor 鈪，
本文编号：2506136
本文链接：https://www.wllwen.com/yixuelunwen/xiaohjib/2506136.html
最近更新
教材专著
