摘要
目的探讨蛋白C、蛋白S和抗凝血酶Ⅲ的缺乏与小儿肝外门静脉高压的关系，明确Rex手术对蛋白C、蛋白S和抗凝血酶Ⅲ的影响。方法2013年12月至2015年1月，23例患儿因＂门静脉海绵样变＂就诊于我院，其中男9例，女14例，年龄2.1-17.5岁，平均6.5岁。18例患儿接受Rex手术治疗，2例患儿接受腹腔镜下脾动脉结扎术治疗，2例为门静脉海绵样变Rex术后复发患儿入院后保守治疗，1例接受Warren手术治疗。所有患儿术前收集血液样本，17例Rex手术后、1例Warren术后、1例脾动脉结扎术后患儿收集静脉全血样本，2例Rex术后复发患儿入院后收集静脉血样本。18例正常儿童血液样本作为对照组。采用蛋白C、蛋白S和抗凝血酶Ⅲ试剂盒，利用ELISA技术检测蛋白C、蛋白S和抗凝血酶Ⅲ的血清浓度和抗凝血酶Ⅲ的活性。结果术前患儿蛋白C、蛋白S和抗凝血酶Ⅲ活性较对照组明显降低（P＝0.000，P＝0.001和P＝0.000）；术前患儿抗凝血酶Ⅲ浓度与对照组差异无统计学意义（P＝0.057）。Rex手术后蛋白C、蛋白S和抗凝血酶Ⅲ活性较术前明显升高（P＝0.000，P＝0.001和P＝0.000）; Rex术后抗凝血酶Ⅲ浓度与术前相比差异无统计学意义（P＝0.959）。Rex术后蛋白C明显高于对照组（P＝0.043）；Rex术后蛋白S、抗凝血酶Ⅲ浓度和抗凝血酶Ⅲ活性与对照组相比差异无统计学意义（P＝0.398，P＝0.134和P＝0.612）。结论小儿肝外门静脉高压蛋白C、蛋白S和抗凝血酶Ⅲ显著降低，Rex手术有利于改善蛋白C、蛋白S和抗凝血酶Ⅲ水平，可能与门静脉血流恢复有关。
Objective To explore the relationship between the deficiency of protein C, protein S and antithrombin Ⅲ and extra-hepatic portal hypertension and evaluate the effects of Rex shunt on protein C, protein S and antithrombin IlL Methods From December 2013 to January 2015, 23 children （9 boys and 14 girls, age： 2. 1-17. 5 years, mean age： 6. 5 years） with portal cavernous lesions were recruited. The procedures included Rex shunt （n = 18）, laparoscopic splenic artery ligation （n = 2）, recurrent portal hypertension with Rex shunt （n = 2） and Warren shunt （n = 1 ）. Blood samples were collected preoperatively in all children, postoperatively in 17 children undergoing Rex shunt and 1 child undergoing Warren shunt and 1 child undergoing laparoscopic splenic artery ligation. And blood samples of two children with recurrent portal hypertension were also withdrawn. Blood samples of 18 normal children were used as controls. The concentrations of protein C, protein S and antithrombin Ⅲ and the activity of antithrombin Ⅲ were detected by enzyme-linked immunosorbent assay （ELISA） kit. Results The preoperative concentrations of protein C and protein S and the activity of antithrombin Ⅲ were significantly lower than those of control group （P = 0. 000, P = 0. 001 ＆ P = 0. 000）. No difference existed between the preoperative concentration of antithrombin Ⅲ and control group （P = 0. 057）. The concentrations of protein C and protein S and the activity of antithrombin Ⅲ after Rex shunt were significantly higher than those prior to Rex shunt （P = 0. 000, P= 0. 001 ＆ P = 0. 000）. No difference existed between the preoperative concentration of antithrombin Ⅲ and that after Rex shunt （P = 0. 959）. The concentration of protein C after Rex shunt was significantly higher than that of control group （P = 0. 043）. No difference existed between the concentrations of protein S and antithrombin Ⅲ and the activity of antithrombin Ⅲ after Rex shunt and control group （P = 0. 398, P
出处
《中华小儿外科杂志》
CSCD
2016年第11期810-814,共5页
Chinese Journal of Pediatric Surgery
基金
北京市自然科学基金（7164242）
北京市优秀人才青年骨干项目（201400002149G224）
北京市属医院科研培育项目（PX2016003）
