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首页> 中文期刊> 《中国中西医结合急救杂志》 >肺栓塞患者治疗后凝血纤溶系统指标变化与血栓近期溶解的关系

肺栓塞患者治疗后凝血纤溶系统指标变化与血栓近期溶解的关系

         
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摘要

目的 探讨肺栓塞(PE)患者治疗后14 d内血浆纤维蛋白原(Fib)、D-二聚体和纤维蛋白原降解产物(FDP)的变化规律及与血栓近期溶解的关系.方法 采用前瞻性研究方法,选择2015年1月至2016年3月4家医院呼吸内科收治的PE患者,入院后进行溶栓或抗凝治疗.于治疗前24 h内和治疗后14 d行CT肺动脉造影(CTPA),以Mastora评分计算肺动脉阻塞指数(PAOI)评估血栓负荷.治疗前及治疗后1、2、3、5、7和14 d测定血浆Fib、D-二聚体和FDP水平,分析其变化规律及与PAOI的相关性.结果 共纳入42例PE患者.PE患者Fib于治疗3d达峰值(g/L:4.24±1.45比3.83±1.56),随后逐渐下降,与二次方曲线模型拟合度最高,但差异均无统计学意义(P=0.095);D-二聚体和FDP治疗后持续下降,治疗后14d达最低[D-二聚体(mg/L):1.58±1.38比8.84±6.35,FDP (mg/L):4.23±3.63比23.41±16.54],与三次方曲线模型拟合度最高(F值分别为32.190和34.326,均P=0.000).治疗前和治疗后14 d PAOI变化量[(18.77±14.22)％]与Fib变化量[(1.20±0.93) g/L]无相关性(r值为-0.194,P=0.219),与D-二聚体变化量[(7.29±7.10) mg/L]和FDP变化量[(19.29±18.67) mg/L]均呈正相关(r值分别为0.556和0.460,P分别为0.020和0.002).结论 PE治疗后D-二聚体和FDP水平持续下降提示血栓溶解.%Objective To discuss the relationships between regular pattern changes of plasma fibrinogen (Fib),D-dimer and fibrinogen degradation products (FDP) levels and the recent dissolution of thrombus in patients with pulmonary embolism (PE) in 14 days after treatment.Methods A prospective study was conducted.PE patients admitted to Departments of Respiratory Disease in 4 hospitals from January 2015 to March 2016 were enrolled and all of them were treated with thrombolysis and/or anticoagulation after admission.The computed tomographic pulmonary angiography (CTPA) was examined pre-treatment and 14 days post-treatment in PE patients.The pulmonary artery obstruction index (PAOI) was assessed according to the Mastora scoring method to estimate the thrombus load.The plasma Fib,D-dimer and FDP levels were measured before and on 1,2,3,5,7 and 14 days after treatment,and the relationships between the change regularities of these parameters and PAOI were also analyzed.Results A total of 42 PE patients were enrolled.The curve change of coagulation-fibrinolytic system parameters in 14 days after treatment showed that the Fib level was raised to its peak on the 3rd day after treatment and then decreased (g/L:4.24 ± 1.45 vs.3.83 ± 1.56),representing that its curve change was in accordance with the quadratic model (P =0.095).After treatment,the D-dimer and FDP levels were kept declining,they were reached the valley on 14th day [D-dimer (mg/L):1.58 ± 1.38vs.8.84 ± 6.35,FDP (mg/L):4.23 ± 3.63 vs.23.41 ± 16.54],and their curve changes were in accordance with the cubic model (F was 32.190 and 34.326,respectively both P =0.000).The PAOI variation before and 14 days after treatment [(18.77 ± 14.22)％] was not correlated with Fib variation [(1.20 ± 0.93) g/L,r =-0.194,P =0.219],but was positively correlated with D-dimer variation [(7.29 ± 7.10) mg/L] and FDP variation [(19.29 ± 18.67) mg/L,r was 0.556 and 0.460,respectively;P was 0.020 and 0.002,respectively].Conclusions The D-dimer and FDP levels are kept falling in PE patients after treatment,suggesting that the pulmonary artery embolus is being dissolved.

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  • 来源
    《中国中西医结合急救杂志》 |2017年第1期|49-53|共5页
  • 作者

    冯宗莲; 梁秋妹; 秦志强; 许承琼; 覃少佳; 梁世廉; 陈桂荣; 刘航; 王毅; 周怀海;

  • 作者单位

    530021广西壮族自治区南宁,广西壮族自治区人民医院呼吸内科;

    530021广西壮族自治区南宁,广西壮族自治区人民医院呼吸内科;

    530021广西壮族自治区南宁,广西壮族自治区人民医院呼吸内科;

    535000广西钦州,广西钦州市第一人民医院呼吸内科;

    546000广西来宾,广西来宾市人民医院呼吸内科;

    543001广西梧州,广西梧州市工人医院呼吸内科;

    530021广西壮族自治区南宁,广西壮族自治区人民医院呼吸内科;

    530021广西壮族自治区南宁,广西壮族自治区人民医院呼吸内科;

    530021广西壮族自治区南宁,广西壮族自治区人民医院放射科;

    530021广西壮族自治区南宁,广西壮族自治区人民医院呼吸内科;

  • 原文格式 PDF
  • 正文语种 chi
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  • 关键词

    肺栓塞; 肺动脉阻塞指数; 纤维蛋白原; D-二聚体; 纤维蛋白原降解产物;

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