维生素K缺乏或拮抗剂诱导的蛋白-Ⅱ在非婴儿获得性维生素K依赖性凝血因子缺乏症中的诊断意义

摘要

目的 探讨维生素K缺乏或拮抗剂诱导的蛋白-Ⅱ(PIVKA-Ⅱ)在非婴儿获得性维生素K依赖性凝血因子缺乏症(ADVKCF)中的诊断价值.方法 对临床确诊的50例ADVKCF患者采用ELISA法检测治疗0、3、7d的血浆中PIVKA-Ⅱ水平,同时分析不同时间点凝血常规和凝血因子促凝活性,并以20例健康体检者作为对照.结果 患者PIVKA-Ⅱ水平为(3.83±1.40) μg/L,健康对照组为(1.30±0.54) μg/L,差异有统计学意义(P＜0.05),患者接受维生素K治疗3d后其值与治疗前相比差异无统计学意义[(3.83±1.40) μg/L比(3.79 ±0.66)μg/L,P＞0.05],7d后其值降低但仍高于对照组水平.近期输注血浆组PIVKA-Ⅱ水平为(3.78±1.30)μg/L,同未输注组[(3.91±1.49)μg/L]相比,差异无统计学意义(P＞0.05).治疗前患者凝血因子Ⅱ、Ⅶ、Ⅸ及Ⅹ活性明显降低(3.68％～12.28％),而凝血酶原时间(PT)、APTT明显延长(＞100 s),治疗1周后基本恢复正常.结论 ADVKCF患者血浆PIVKA-Ⅱ的水平升高,维生素K治疗1周后其值仍高于正常人的水平,且不受血浆输注的影响,PIVKA-Ⅱ较凝血常规、凝血因子活性检测更为灵敏,具有早期辅助诊断本病的价值.%Objective To explore the diagnostic value of protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) in non-infant with acquired deficiency of vitamin K-dependent coagulation factors (ADVKCF).Methods PIVKA-Ⅱ levels were measured by ELISA in 50 patients with ADVKCF on day 0,3,7 after vitamin K treatment.Prothrombin time(PT),APTT,FⅡ ∶ C,FⅦ∶ C,FⅨ∶ C,and FⅩ∶ C were analyzed simultaneously.Twenty healthy subjects were enrolled as controls.Results The average level of PIVKA-Ⅱ in ADVKCF group was (3.83 ± 1.40) μg/L,while (1.30 ± 0.54) μg/L in the control group (P ＜ 0.05).The PIVKA-Ⅱ levels on day 0 and 3 did not show significant difference [(3.83 ± 1.40) μg/Lvs (3.79 ± 0.66) μg/L,P ＞ 0.05],but decreasing significantly on day 7 compared to the control group (P ＜ 0.05).The PIVKA-Ⅱ level was (3.78 ± 1.30) μg/L in patients receiving plasma transfusion,while (3.91 ± 1.49)μg/L in no-plasma-transfusion group (P ＞ 0.05).Coagulation factors Ⅱ,Ⅶ,Ⅸ and Ⅹ activity which decreased significantly before treatment returned to normal range after one week use of vitamin K,leading to complete correction of prolonged APTT and PT (＞ 100 seconds).Conclusions The PIVKAⅡ level in ADVKCF patients is significantly higher than that of healthy subjects within one week treatment of vitamin K,which is not influenced by plasma transfusion.This study suggests that PIVKA-Ⅱ is a more sensitive parameter than APTT,PT and the activity of coagulation factor,which could be a valuable factor in the early diagnosis of ADVKCF.