肾综合征出血热血浆 P-选择素和组织因子的变化及其与凝血功能紊乱的关系

摘要

Objective To investigate the changes of Ps-electin ( P-sel) and tissue factor ( TF) in hemorrhagic fever with renal syndrome ( HFRS) and the correlation between the changes and blood coagulation function disorder ,so as to direct clinical treatment .Methods Twenty -seven patients with HFRS were divided into two groups according to the severity of illness,mild case group ( n =13) and severe case group ( n =14),and 20 healthy subjects were served as control group .The levels of plasma P-sel and TF were detected by enzyme-linked immunosorbent assay (ELISA),coagulogram was measured by immunoturbidimetry,blood urea nitrogen (BUN) and creatinine (Cr) were detected by automatic biochemical analyzer ,and platelet parameters were determined by automatic blood cell classification analyzer for both groups .Results In pyretogenic stage of HFRS,the plasma levels of TF in severe case group were significantly higher than those of mild case group ( P <0.01).The plasma levels of P-sel were positively correlated to those of polymorphonuclear neutrophils (PMN) and monocytes (mo) ( r =0.661,0.513, P <0.01).The change curve of TF was basically coincident with that of APTT ,INR,D-D,BUN, however,which was opposite to that of Fn ,platelet.The correlation analysis showed that the plasma levels of TF were positively correlated to those of APTT,INR,D-D,BUN ( r =0.436,0.351,0.386,0.362,respectively, P <0.05),however,which were negatively correlated to those of Pt ( r =-0.405, P <0.01).Conclusion The plasma P-sel plays an important role in promoting the interaction between white blood cell and endothelial cells .The increase of TF expression is the important reason of causing clotting mechanism disorder and resulting in renal function lesion .%目的：探讨肾综合征出血热（ HFRS）患者血浆P-选择素（ P-sel）、组织因子（ TF）的变化及其与凝血功能紊乱的关系，以便指导临床治疗。方法27例HFRS患者按病情分为轻症组和重症组，轻症组13例，重症组14例，分别在不同病期采集抗凝血分离血浆，用酶联免疫吸附试验（ ELISA）检测P-sel与TF，血凝固法检测凝血象，乳胶增强免疫比浊法检测D-D，自动生化仪检测血尿素氮（BUN）、肌酐（Cr），血球分类仪检测血小板（Pt）参数；另取20名健康者作对照。结果在发热期，重症组血浆TF水平显著高于轻症组（ P ＜0．01）。血浆P-sel与中性白细胞（PMN）、单核细胞（Mo）之间呈正相关（df＝79， r值分别为0．661与0．513， P ＜0．01）。 TF的变化曲线与APTT、 INR、D-D、BUN的变化曲线基本一致，而与Fn、血小板的变化趋势相反。相关分析表明血浆TF与APTT、INR、D-D、BUN之间呈正相关（dg＝60， r值分别为0．436、0．351、0．386、0．362， P ＜0．05），与Pt之间呈负相关（df＝79， r ＝-0．405， P ＜0．01）。结论 HFRS急性期血浆P-sel、TF水平显著上升，提示体内存在内皮细胞损伤和血小板活化。血浆P-sel与PMN、Mo呈显著正相关，表明P-sel在动员白细胞与内皮细胞的相互作用中起重要作用。血浆TF与BUN、APTT、INR、D-D呈正相关，表明TF之表达增加是引起凝血机制率乱并导致肾功能损害的重要原因。故而强烈建议在病程早期当出现DIC或DIC前期表现时宜适当应用低分子肝素等抗凝剂治疗。