摘要
目的 寻找监测肝移植后排斥反应、血栓形成、冲击疗效和判断预后的敏感和特异性指标。方法 随机观察肝移植患者 41例 ,其中出现排斥反应 16例 (急性排斥 12例、慢性排斥 4例 )。定期检测凝血因子Ⅶ、(FⅦ )、Ⅷ (FⅧ )、Ⅸ (FⅨ )和Ⅺ (FⅪ ) ,血栓调节蛋白 (sTM )、血管性假性血友病因子 (vWF)和D 二聚体含量。结果 ①肝移植后有排斥者FⅦ ( 73 .3 %± 7.9%)和FⅧ ( 75 .7%± 9.1%)均明显降低 ,sTM [( 6.2 7± 0 .2 2 )ng/ml]、vWF( 114 .6%± 6.8%)和D 二聚体 [( 5 .5 1± 0 .65 )mg/L]则明显升高。②肝移植后有血栓形成者FⅦ ( 69.4%± 8.8%)、FⅨ ( 70 .3 %± 6.3 %)、FⅪ( 60 .0 %± 9.7%)均明显降低 ,在术后第 13天达最低水平。③肝移植后有血栓形成并有排斥反应者 ,血FⅦ ( 4 5 .3 %± 2 .5 %)、FⅪ ( 5 0 .7%± 5 .6%)活性比有血栓无排斥者更低 ,而sTM [( 7.42± 0 .48)ng/ml]、vWF( 12 2 .7%± 5 .7%)和D 二聚体 [( 6.3 5± 1.18)mg/L]则升高更明显。④急性排斥患者sTM [( 7.88± 0 .2 9)ng/ml]高于慢性排斥者 [( 6.3 5± 0 .3 4)ng/ml]。⑤在冲击治疗无效组患者 ,sTM [( 8.3 0± 0 .19)ng/ml]和D 二聚体 [( 8.3 2± 0 .99)mg/L]均明显高于有效组 [( 3 .82± 0 .2 2 )ng/ml、( 4 .3 0± 0 .
Objective To find sensitive and specific markers for monitoring transplantation reject reaction, thrombosis, the effect of coticosteroid pulse therapy and predicting prognosis.Methods Forty one liver transplantation cases were investigated randomly, among them 16 cases developed reject reaction (acute rejection 12, chronic rejection 4). Levels of coagulation facotr Ⅶ(FⅦ),Ⅷ(FⅧ),Ⅸ(FⅨ),Ⅺ(FⅪ), soluble thrombomodulin (sTM), von Willebrand factor (vWF) and D dimer (D D) were measured every other day before and after operation.Results ① The levels of FⅦ(73.3%±7.9%) and FⅧ(75.7%±9.1%) decreased significantly in reject reaction cases after liver transplantation, while sTM [(6.27±0.22)ng/ml], vWF[(114.6%±6.8%)] and D D [(5.51±0.65)mg/L] increasd significantly. ② In cases with thrombosis after liver transplantation, FⅦ(69.4%±8.8%),F Ⅸ(70.3%±6.3%) and FⅪ(60.0%±9.7%) decreased significantly. They reached the lowest level 13 days after operation. ③ The levels of FⅦ(45.3%±2.5%) and FⅪ(50.7%±5.6%) were lower in cases that developed thrombosis and rejection after liver transplantation than those had thrombosis but without reject reaction, and sTM [(7.42±0.48)ng/ml]、vWF(122.7%±5.7%) and D D [(6.35±1.18)mg/L] increased more obviously. ④ sTM level in acute rejection [(7.88±0.29)ng/ml] was higher than that in chronic rejection [(6.35±0.34)ng/ml]. ⑤ Levels of sTM [(8.30±0.19)ng/ml] and D D [(8.32±0.99)mg/L] in group not respond to pulse therapy were much higher than those with respond [(sTM (3.82±0.22)ng/ml, D D (4.30±0.28)mg/L]. Levels in dead patients [sTM (7.98±0.18)ng/ml, D D (7.98±1.19)mg/L] were higher than those in survived patients [(sTM (6.51±0.41)ng/ml, D D (5.49±0.39) mg/L ]. ⑥ FⅪ level in survived group (82.3%±7.7%) was higher than that in dead patients group (60.2%±4.4%). Conclusions ① Plasma sTM, vWF and D D can be taken as the markers of judging reject reaction after liver transplantation. FⅦ can be a supplemental marker to judge r
出处
《肝脏》
2004年第2期80-83,共4页
Chinese Hepatology
基金
广州市科技重点攻关项目 (97 Z 48 0 5)
关键词
肝移植
排斥反应
血栓形成
凝血因子
Liver transplantation
Reject reaction
Thrombosis
Coagulation Factor
