《血浆凝血酶调节蛋白检测的临床研究》由会员分享，可在线阅读，更多相关《血浆凝血酶调节蛋白检测的临床研究（18页珍藏版）》请在金锄头文库上搜索。
1、血浆凝血酶调节蛋白检测的临床研究【摘要】 为了探讨血浆凝血酶调节蛋白（PTM）检测的临床价值，用ELISA法测定979例患者的PTM，并选择60名健康人作为对照。结果表明：对照组PTM 水平为20.407.72 g/L，无性别和年龄差异。在疾病组中，原发性慢性肾小球疾病肾功能衰竭（CRF）组PTM水平高于无CRF组，败血症组PTM水平高于非败血症组，多脏器功能衰竭（MOF）组PTM水平高于无MOF组（P<0.01）；以>70、>50和>40 g/L为标准，分别预示CRF、败血症和MOF的灵敏度为85.7%、86.6%和77.8%，特异性为82.4%、89.5%和77.3
2、%，阳性预示值为77.8%、76.5%和73.7%。系统性红斑狼疮（SLE）尿蛋白阳性组PTM水平高于阴性组；糖尿病并发症组的PTM水平高于无并发症组，并发微血管病变组的PTM水平高于大血管病变组（P均<0.01）；以PTM高于正常上限值（>35.54 g/L）为标准，预示SLE尿蛋白阳性临床肾损害、糖尿病并发症和微血管病变的灵敏度为77.8%、53.4%和71.2%，特异性为92.3%、97.1%和97.1%，阳性预示值为93.3%、98.6%和97.9%。急性白血病（AL）和多发性骨髓瘤（MM）初诊 时PTM升高，两病并发肾衰时极度升高（P<0.01）。动态检测多发伤、脑
3、卒中急性期和恢复期、AL和MM化疗前后、癌症术前后PTM水平与病情变化相关。以微血管病变为主要疾病的PTM 水平高于大血管病变疾病 （P<0.01）， 以高于正常上限值为标准，微血管病变疾病的灵敏度为77.7%、特异性71.2%，阳性预示值75.6%。结论：PTM水平是评估微血管病变疾病的良好指标，也是预警或评估疾病严重程度及其演变或疗效观察的有用指标。 【关键词】 血浆凝血酶调节蛋白 疾病严重程度/并发症 微血管病变 大血管病变 Thrombomodulin (TM), a thrombinbinding glycoprotein expressed on the endothelia
4、l cell surfaces in various tissues, is involved in negative regulation of coagulation through the activation of protein C1. The soluble form of TM, which was arised by proteolytic cleavage from membrane TM on endothelial cells, can be detected in human plasma and urine. Since the plasma TM concentra
5、tion is elevated in a variety of diseases accompanied by endothelial injury, soluble TM is believed to be a good indicator of endothelial damage or activation2,3. Plasma TM is not specific for diagnosis of single disease, but it may be helpful to demonstrate the presence of microangiopathy and to as
6、sess the severity or complication of diseases. Materials and Methods Patients and healthy controls 979 patients admitted to the second hospital of Zhejiang University from 1996 to 2004 were included in this study. The patients were 542 men and 437 women with mean age of 47.618.5 years old (range, 15
7、 to 91 years). Sixty healthy volunteers with mean age of 38.616.2 years old (range, 12 to 77 years) were included in control group. The sex and age of the healthy volunteers, the characteristics of the patients including disease stage, complications and severity are summarized in table 1 and 2. Meth
8、ods The levels of plasma TM were measured by enzymelinked immunosorbent assay (ELISA) kit according to manufacture s instruction (STAGO, France). Venous blood was collected into 3.2% sodium citrate (9 parts of blood 1 part of anticoagulant) using a 10ml syringe with a 21gauge needle. Plasma was obta
9、ined by centrifuging the blood at 1 500 g for 30 minutes. The plasma samples were frozen and stored at -70 until the assay. Statistical analysis The results were expressed as meanSD, and POMS statistical package was used for multivariate analysis, students t test and correlation analysis. Statistica
10、l significance was defined as P value<0.05 for a twotailed test. Results PTM level in control group As shown in Table 1, the PTM level in healthy control group was 20.407.72 g/L, no significant difference was observed between different age and sex. Here we defined PTM level higher than its normal
11、 upper limit (1.96 SD, i.e. 35.54 g/L) as PTM positive criterion, and the positive rate of the control group was less than 5%. Table 1. PTM levels of the different sex and age in healthy controls（SD） nPTM（g/L） female2521.168.33male3519.867.3325 years old1819.508.2926-45 years old2020.357.7846-77 yea
12、rs old2221.417.60 PTM levels in relation with the severity and complications of diseases Cardiocerebral vascular disease The diagnosis was made based on the criteria proposed at the 4th National Conference on Cerebrovascular Disease. Cerebral infarction within 3 days showed significant higher PTM le
13、vel than the transient ischemic attack (P<0.01), but only 32.1% of the PTM were positive, similar to those of cerebral hemorrhage (33.9%) and coronary heart disease (12.9%). In patients with essential hypertension, PTM level is correlated with hypertension stages (Table 2). Among 137 patients suf
14、fering from stroke, 27 were accompanied by diabetes, 28 by hypertension or coronary heart disease, 6 by renal diseases and 76 without underlying diseases, PTM levels of these patients were 31.3712.06 g/L, 32.4712.08 g/L, 60.0023.52 g/L and 31.5114.13 g/L respectively. Patients with renal diseases ha
15、d significantly higher PTM than other patients(P<0.01). No correlation was found between PTM and blood glucose (r=0.0360), cholesterol (r=-0.0587) and triglyceride (r=0.0542) among 280 cardiocerebral vascular diseases or diabetes. PTM was not correlated with fibrinogen (r=0.087) and fibrin degrad
16、ation product (FDP) (r=0.026) in 81 cases (P>0.05). 26 patients with cerebral infarction and 22 patients with cerebral hemorrhage for at least 141 days had been followed up PTM dropped when the disease was remitted (cerebral infarction: 31.6711.50 g/L vs 23.089.37 g/L, P<0.01, and cerebral hemorrhage: 33.617.24 g/L vs 27.945.83 g/L, P =0.02). Primary chronic glomerular
