【摘要】 目的探讨肾综合征出血热(HFRS)患者血浆血管性血友病因子(vWF)、D-二聚体(D-D)、血小板参数的变化及临床意义。方法 18例HFRS患者按病情分为轻、重两组,每组各9例,按病期采血,用酶联免疫吸附测定(ELISA)检测vWF,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)、丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST),自动血细胞分析仪检测血小板参数;另取20例健康者作对照。结果 HFRS患者从发热期至恢复初期血浆vWF与D-D含量皆显著升高,峰值分别出现在发热期与低血压少尿期,与对照组相比,差异有统计学意义,vWF(363.69±54.30)μg/L vs(170.40±29.35)μg/L(P<0.01);D-D(4.17±2.66)μg/L vs(0.17±0.07)μg/L(P<0.01)。轻、重二组之间vWF差异无统计学意义,但D-D含量在低血压少尿期差异有统计学意义,(4.17±2.66)μg/L vs(1.88±0.48)μg/L(P<0.01);D-D的变化曲线与BUN、ALT、AST的变化趋势基本一致,而与血小板的变化趋势相反。结论 HFRS急性期血浆vWF与D-D水平显著升高,血小板计数显著降低,同时伴肝、肾功能异常,提示体内存在广泛性毛细血管损伤和凝血系统的激活,早期适量应用低分子肝素等抗凝剂治疗,可望改善微循环,减轻多器官损害。更多还原

【Abstract】 Objective To study the changes and clinical significance of plasma von Willebrand factor(vWF),D-dimer(D-D) and platelet parameters in patients of hemorrhagic fever with renal syndrome(HFRS).Methods According to the severity of disease,18 cases with HFRS were divided into two groups(moderate group and severe group,each group 9 cases),and 20 healthy individuals served as control group.Blood samples were collected at every stage of the disease,plasma vWF was detected by enzyme-linked immunosorbent assay(ELISA),plasma D-D by latex-enhanced turbidimetric immunoassay,blood urea nitrogen(BUN),creatinine(Cr),alanine aminotransferase(ALT) and aspartate transaminase(AST) by automatic biochemical analyzer,and platelets by automated hematologic analyzer.Results Compared with control group,the plasma levels of vWF and D-D were significantly higher through the disease course with pick values in febrile and hypotension-oliguric stage of HFRS,vWF(363.69±54.30) μg/L vs(170.40±29.35) μg/L(P<0.01);D-D(4.17±2.66) μg/L vs(0.17±0.07) μg/L(P<0.01).There was no significant difference in plasma vWF levels between moderate group and severe group,but significant difference was observed in plasma D-D levels during hypotension-oliguric stage,(4.17±2.66) μg/L vs(1.88±0.48) μg/L(P<0.01).The variation curve of D-D was in line with that of BUN,ALT and AST,but was contrary to blood platelet count.Conclusion Significantly elevated plasma levels of vWF and D-D and decreased blood platelet count coincident with hepatic and renal dysfunction were observed in the acute phase of HFRS,suggesting the presence of extensive capillary injury associated with activation of coagulation system.Accordingly,it is important in the early stage to use anticoagulants such as low molecular mass heparin to improve microvascular disturbance and to alleviate multiple organ damage.更多还原