出凝血分子标志物在弥散性血管内凝血中的动态变化及意义

发布时间：2018-04-16 06:53

  本文选题：出凝血分子标志物 + 弥散性血管内凝血　； 参考：《山东大学》2017年硕士论文

【摘要】：目的探讨凝血酶-抗凝血酶复合物(thrombin-anti-thrombin complex,TAT)、纤溶酶-α 2 纤溶酶抑制剂复合物(plasmin-α 2-plasmin inhibitor complex,PIC)、血栓调节蛋白(tlrombomodulin,TM)、组织型纤溶酶原激活剂-纤溶酶原激活物抑制剂复合物(tissue-type plasminogen activator-plasminogen activator inhibitor complex,t-PAl-C)四种出凝血分子标志物在弥散性血管内凝血(Disseminated Intravascular Coagulation,DIC)的动态变化,评估其对于DIC早期诊断的意义。方法所有33例研究对象选自2016年9月至2017年3月山东大学齐鲁医院收治的凝血机能障碍患者。33例患者入院时9例确诊为DIC,24例疑诊DIC,疑诊组中5例发展为DIC。根据最终诊断将33例研究对象分为DIC组(14例)和非DIC组(19例)。在患者入院后第1、3、7天,用高敏化学发光法检测患者血浆TAT、PIC、TM、t-PAI-C的浓度。另取正常对照组30人,排除血液系统疾病、感染、外伤、血栓性疾病、肝肾疾病等,测定其血浆TAT、PIC、TM、t-PAI-C的浓度。结果第 1、3 天 DIC 组血浆 TAT 水平(16.83±13.21,21.66±24.58)ng/mL 明显高于非 D1C 患者(4.9±2.62,3.47±1.69)ng/mL,P 值分别为(0.005,0.016)。第1天DIC组血浆PIC水平(4.63±6.23)μ g/mL明显高于非DIC组患者(0.93±0.59)μg/mL,P值为 0.045。第1、3、7天DIC组血浆TM水平(31.31±18.75,36.61±20.31,30.21±18.32)TU/mL 均高于非 DIC 组(11.19±2.99,11.1±4.32,11.37±3.88)TU/mL,P 值分别为(0.001,0.001,0.002)。第7天DIC组血浆t-PAI-C水平(24.23±29.9)ng/mL高于非DIC组患者(6.72±4.56)ng/mL,P 值为 0.048。DIC 患者的血浆 TAT(18.10±21.23)ng/mL,PIC(3.80±5.02)u g/mL,TM(32.71±18.88)TU/mL,t-PAI-C(23.93±32.30)ng/mL,明显高于非 DIC 患者 TAT(4.37±4.40)ng/mL,PIC(1.03±0.69)μg/mL,TM(11.22±3.71)TU/mL,t-PAI-C(6.87±4.35)ng/mL,P 值分别为0.001,0.001,0.001,0.001,均有统计学差异。第1天血浆TAT、TM的ROC曲线下面积分别为0.83、0.91,P值均0.01。结论DIC早期即发生血浆凝血酶-抗凝血酶复合物(thrombin-anti-thrombin complex,TAT)、纤溶酶-α 2 纤溶酶抑制剂复合物(plasmin-α 2-plasmin inhibitor complex,PIC)、血栓调节蛋白(thrombomodulin,TM)浓度的显著升高,动态检测血浆TAT、PIC、TM的水平有助于DIC的早期诊断。
[Abstract]:Objective to investigate the thrombin antithrombin complex thrombin-anti-thrombin complex, plasmin- 伪 2 plasmin- 伪 2-plasmin inhibitor complex, thrombombomodulinTMN, tissue type plasminogen activator / plasminogen activator inhibitor complex tissue-type plasminogen activator-plasminogen activator.The dynamic changes of inhibitor complext-PAl-C4 molecular markers in disseminated intravascular coagulation (DICs).To evaluate its significance for early diagnosis of DIC.Methods all 33 patients were selected from Qilu Hospital of Shandong University from September 2016 to March 2017. Nine of 33 patients with coagulation dysfunction were diagnosed as DICs on admission, and 5 of them in suspected group were diagnosed as DICs.According to the final diagnosis, 33 cases were divided into DIC group (n = 14) and non DIC group (n = 19).On the 1st day after admission, Gao Min chemiluminescence assay was used to detect the plasma TATICPICT T PAI-C concentration.The plasma levels of TATICPICT-PAI-C were determined in 30 normal control subjects, excluding blood system diseases, infections, trauma, thrombotic diseases, liver and kidney diseases, and so on.Results the plasma TAT level in the DIC group was significantly higher than that in the non-D1C group on the 1st day (16.83 卤13.21 卤21.66 卤24.58)ng/mL, 4.9 卤2.62 卤3.47 卤1.69 ng / mL, P = 0.005 卤13.21 卤21.66 卤0.016), respectively.On the first day, the plasma PIC level in DIC group was 4.63 卤6.23 渭 g/mL significantly higher than that in non- group (0.93 卤0.59) 渭 g / mL (P = 0.045).The plasma TM level in the DIC group was 31.31 卤18.75 卤20.31 卤20.31 卤20.31 卤30.21 卤18.32)TU/mL on the 7th day, which was higher than that in the non- group (11.19 卤2.99 卤11.1 卤4.32 卤11.37 卤3.88 Tu / mLN P = 0.001 卤0.001).绗，

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