【作者】 曾晓春；

【导师】 伍伟锋；

【作者基本信息】 广西医科大学 ， 内科学心血管， 2008， 硕士

【摘要】 目的:观察先天性心脏病房间隔缺损(ASD)患者植入封堵器后血浆凝血酶原片段1+2(F1+2)及血小板P选择素(CD62P)、血小板膜糖蛋白Ⅱb/Ⅲa受体(CD41a)的变化及其意义。方法:选择40例成功以Amplatzer进行房缺封堵术的病人,用EHSA法及流式细胞术(FCM)分别测定他们术前、术后1-2d、术后1m、术后3m F1+2水平及血小板CD62P、CD41a的表达。结果:(1)ASD患者术后1-2d较术前组的F1+2水平明显增高,由0.96±1.19nmol/L增高到术后1-2d的1.43±1.49nmol/L,术后1月降低明显,术后3m时恢复到接近术前的0.98±1.10nmol/L。(2)ASD患者术后1-2d、术后1m、术后3m的CD62P及CD41a表达均较术前明显下降,由(8.22±2.11)%及(79.36±14.15)%降至术后3月时的(4.41±1.11)%及(54.88±11.62)%。(3)ASD病人在术后1-2d及术后1m、术后3m右室内径(RVD)均较术前缩小,而左室舒末径(LVDd)较术前增大。(4)ASD患者术前RVD与术前血小板CD62P、CD41a呈正相关;ASD大小与术前血小板CD62P呈正相关,与术前CD41a无相关关系。结论:ASD封堵术后凝血功能一过性增强,1月后开始明显下降,3月后大致恢复术前水平;而血小板活性在术后却降低;房缺封堵术后患者的RVD、LVDd呈现出逐渐恢复正常大小的趋势;术前血小板活化程度与RVD及房缺大小呈正相关。更多还原

【Abstract】 Objective To investigate the changes of the levels of prothrombin fragment 1 + 2(F1 + 2),P-selectin(CD62P)and platelet glycoproteinⅡb/Ⅲa receptor(CD41a)among patients following transcatheter ASD closure.Methods Forty consecutive patients who underwent successful transcatheter closure of an ASD defect with the Amplatzer septal occluder were prospectively studied.Measurements of the F1 + 2 levels and the percentage of activated platelets(evaluated by CD62P and CD41a) expression detected by flow cytometry)were taken at baseline just before the procedure as baseline,and at 1,30 and 90 days following device implantation.We therefore evaluated the presence,degree and timing of the activation of the coagulation and platelet systems following transcatheter closure of ASDs.Result(1)F1 + 2 levels increased from 0.96±1.19 nmol/1 at baseline to a maximal value of 1.43±1.49 nmol/1 at 1 days,gradually returning to the baseline levels at 90 days(0.98±1.10 nmol/1)(p＜0.05).(2)CD62P and CD41a decreased from(8.22±2.11)%and(79.36±14.15)%to(4.41±1.11)% and(54.88±11.62)%at 90 days.(3)RVD of patient with ASD dicreased after operation 1-2 day,1 month and 3 month,while LVDd increased at the same time.(4)Before the operation,CD62P and CD41a were both positive correlated with RVD;The size of ASD was positive correlated with CD62P, but not with CD41a.Conclusions Transcatheter closure of ASDs with the Amplatzer septal occluder was associated with significant increase coagulation activation and a significant decrease in the platelet system activation.The patient’s RVD,and LVDd tended to be normal following transcatheter closure of ASDs.Before the procedure,the degree of platelet activation, RVD and the size of Atrial septal defects were positive correlated.更多还原