【摘要】 目的:观察慢性阻塞性肺疾病患者急性发作期血液高凝状态的变化。方法:选择2003-01/2003-10上海市扬浦区中心医院呼吸内科住院慢性阻塞性肺疾病急性发作期患者30例为患者组,男20例,女10例。选择同期本院健康体检自愿者25名为对照组,男15名,女10名。均自愿参加。给予慢性阻塞性肺疾病急性发作期患者常规治疗。患者组在入院当天及病情稳定出院前取动脉血1mL作血气分析,包括氧分压、二氧分碳分压和血pH值。取静脉血1mL送检白细胞、中性粒细胞。采用酶联免疫吸附反应检测两组对象静脉血中P-选择素、D-二聚体、血管性血友病因子、组织纤溶酶原激活剂、纤溶酶原激活抑制物1的水平。结果:按意向处理分析,慢性阻塞性肺疾病急性发作期患者30例,健康人25人均进入结果分析。①检测动脉血P-选择素水平反映血小板活化程度:患者组治疗前后明显高于对照组(t=9.17,4.02,P<0.01),患者组治疗前明显高于治疗后(t=7.66,P<0.01)。②检测D-二聚体、血管性血友病因子水平反映血液是否处于高凝状态及内皮细胞功能:患者组治疗前明显高于对照组和治疗后(t=3.92～10.42,P<0.01)。③检测纤溶酶原激活抑制物1水平反映人体纤溶功能:患者组治疗前后明显高于对照组(t=8.59,8.69,P<0.01)。④检测组织纤溶酶原激活剂水平反映人体纤溶功能:患者组治疗前后明显低于对照组(t=18.33,18.42,P<0.01)。治疗后恢复不明显。⑤慢性阻塞性肺疾病急性期患者动脉血氧分压、二氧化碳分压、pH值、白细胞、中性粒细胞与血小板活化因子及纤溶功能的相关性:氧分压与纤溶酶原激活抑制物1、血管性血友病因子呈显著负相关(r=-0.364,-0.410,P<0.05);二氧化碳分压与D-二聚体呈显著正相关(r=0.442,P<0.05),与组织纤溶酶原激活剂呈显著负相关(r=-0.481,P<0.01);pH与P-选择素、纤溶酶原激活抑制物1、血管性血友病因子呈显著负相关(r=-0.367,-0.387,-0.404,P<0.05),与组织纤溶酶原激活剂呈正相关(r=0.659,P<0.01);白细胞、中性粒细胞均与P-选择素呈显著正相关(r=0.413,0.351,P<0.05)。结论:①P-选择素参与慢性阻塞性肺疾病急性发作期的炎症反应过程,急性发作期时血液处于高凝状态,血管内皮细胞受损,纤溶功能受损。②缺氧、酸碱失衡、炎症影响血小板功能。更多还原

【Abstract】 AIM:To observe the changes of blood hypercoagulable state in patients with chronic obstructive pulmonary diseases at acute exacerbation.METHODS:Thirty patients with chronic obstructive pulmonary diseases at acute exacerbation(patient group,20 males and 10 females) at(68± 5) years of age,who were hospitalized in the Department of Respiratory Medicine,Yangpu District Central Hospital of Shanghai City between January and October 2003,and 25 healthy physical examinees(healthy control group,15 males and 10 females) at the mean age of(64± 2) years in this hospital at the same period were voluntarily involved in this study.Patients with chronic obstructive pulmonary diseases at acute exacerbation received regular treatment,and on the day of admission and at discharge when the conditions were stable, their arterial blood(1 mL) was taken for blood gas analysis,including partial pressure of oxygen,partial pressure of carbonxide and pH value of blood;And 1 mL venous blood was drawn to examine leucocyte and neutrophilic granulocyte.The levels of P selectin,D dimer,von Willebrand factor,tissue plasminogen activator and plasminogen activator inhibitor 1 in venous blood were detected in the subjects of both groups with Enzyme linked immunoadsordent assay.RESULTS:According to intention to treat analysis,all the 30 patients with chronic obstructive pulmonary diseases at acute exacerbation and 25 healthy controls were involved in the analysis of results.① Detection of P selectin level in arterial blood,which reflected the degree of platelet activation:It was obviously higher in the patient group before and after treatment than in the control group(t=9.17,4.02,P< 0.01);In the patient group,it was markedly higher before treatment than after treatment (t=7.66,P< 0.01).② Detection of D dimer and von Willebrand factor levels,which reflected whether blood was at hypercoagulable state and the endothelial function:Those in the patient group before treatment were obviously higher than those in the control group and those after treatment(t=3.92 to 10.42,P< 0.01).③ Detection of plasminogen activator inhibitor 1 level,which reflected the systemic fibrinolysis of body:It was obviously higher in the patient group before and after treatment than in the control group(t=8.59,8.69,P< 0.01).④ Detection of tissue plasminogen activatorlevel,which reflected the systemic fibrinolysis of body:It was obviously higher in the patient group before and after treatment than in the control group(t=18.33,18.42,P< 0.01);The recovery after treatment was not obvious.⑤ Associations of the partial pressure of oxygen, partial pressure of carbonxide and pH value,leucocyte and neutrophilic granulocyte with platelet active factor and fibrinolysis:The partial pressure of oxygen was significantly and negatively correlated with plasminogen activator inhibitor 1 and von Willebrand factor(r=- 0.364,- 0.410,P< 0.05);The partial pressure of carbonxide had significant positive correlation with D dimer(r=0.442,P< 0.05),but significant negative correlation with tissue plasminogen activator(r=- 0.481,P< 0.01);The pH value was significantly and negatively correlated with P selectin,plasminogen activator inhibitor 1 and von Willebrand factor(r=- 0.367,- 0.387,- 0.404,P< 0.05),but positively correlated with tissue plasminogen activator(r=0.659,P< 0.01);Both leucocyte and neutrophilic granulocyte had significant positive correlation with P selectin(r=0.413,0.351,P< 0.05).CONCLUSION:① P selectin is involved in the process of inflammatory reaction of chronic obstructive pulmonary diseases at acute exacerbation;At acute exacerbation,blood is at hypercoagulable state,vascular endothelial cells and fibrinolysis are damaged.② Platelet function can be affected by hypoxia,disturbance of acid base balance and inflammation.更多还原