胆固醇结石病人胆囊胆汁凝血和继发性纤溶亢进的研究-东南大学学报医学版

胆固醇结石病人胆囊胆汁凝血和继发性纤溶亢进的研究

作者：唐兆贺¹ 秦永林¹ 叶生爱¹ 芮宗道¹ 范新¹ 王凤臣¹ 高乃荣¹ 陈菊² 芦慧霞² 嵇振岭¹ 杨德同¹ 汤文浩¹

单位：1.东南大学附属中大医院普外科,江苏南京,210009； 2.东南大学附属中大医院检验科,江苏南京,210009

分类号：R575.62, R364.25

出版年·卷·期（页码）：2002·21·第一期（93-97）

摘要：

目的:通过研究胆囊胆固醇结石(简称胆石)病人胆囊胆汁中凝血和纤溶状态来探讨胆囊结石的形成机制.方法:收集胆石病人胆囊胆汁26份和非胆石病人胆囊胆汁17份,测定胆汁中的组织因子抗原、组织因子途径抑制物抗原、凝血酶原片段F1+2抗原、凝血因子Ⅷ抗原、纤维蛋白原抗原、抗凝血酶Ⅲ抗原与活性、蛋白C抗原与活性、总蛋白S、游离蛋白S和纤维蛋白特异性降解产物D-二聚体抗原.结果:胆石组胆囊胆汁中组织因子抗原、抗凝血酶Ⅲ抗原、抗凝血酶Ⅲ抗原与活性之比值、凝血酶原片段F1+2抗原、凝血因子Ⅷ抗原、纤维蛋白原抗原、D-二聚体抗原、纤溶酶活性均高于非胆石组(P<0.05或P<0.01),两组间组织因子途径抑制物抗原和蛋白C抗原、纤溶酶原激活物抑制物活性均无显著性差异,胆石组抗凝血酶Ⅲ活性以及纤溶酶活性与凝血活性指标之比均低于非胆石组(P<0.05).结论:胆石病人胆囊胆汁中的凝血和纤溶活性均高于非胆石者,但抗凝活性并没有相应增强,胆石病人纤溶活性增高的程度与凝血活性相比明显减低,从而有利于胆囊胆汁中交联纤维蛋白积累.组织因子是胆石病人胆囊胆汁中凝血活性亢进的启动因子.

Objective To study the effects of coagulatic and fibrinolytic activities on production of fibrin in acalculous and calculous human gallbladder bile.Methods Coagulatic and fibrinolytic components,and D dimer antigen were studied in the gallbladder bile of patients with gallstones (26 patients) compared with those without gallstones (17 patients).Results Tissue factor concentration was higher in the bile of patients with gallstones than those without gallstones ± s ,(5.646± 1.682 )ng·L -1 ,versus(0.478±0.055)ng·L -1 , P <0.01].But there was no significant difference in the antigen of tissue factor pathway inhibitor between the two groups .But there was no significant difference in the antigen of tissue factor pathway inhibitor between the two groups ± s ,(12.52±2.11)ng·L -1 ,versus(11.67±3.24)mg·L -1 ].Prothrombin fragment F 1+2 was higher in gallstone group than that in controls .Prothrombin fragment F 1+2 was higher in gallstone group than that in controls ± s ,(40.638±6.694)nmol·L -1 ,versus(14.659±2.612)nmol·L -1 , P <0.05].Factor Ⅷ antigen was strikingly higher in gallstone group than that in controls .Factor Ⅷ antigen was strikingly higher in gallstone group than that in controls ± s ,(492.42± 151.26 )mg·L -1 ,versus(116.82±17.55)mg·L -1 , P <0.01].Fibrinogen was significantly higher in gallstone group than that in controls .Fibrinogen was significantly higher in gallstone group than that in controls ± s ,(8.340±0.886)g·L -1 ,versus(2.542±0.622)g·L -1 , P <0.01].Antithrombin Ⅲ antigen was detected in much greater concentration in the bile of patients with gallstones than those without gallstones .Antithrombin Ⅲ antigen was detected in much greater concentration in the bile of patients with gallstones than those without gallstones ± s ,(348.379±86.013)mg·L -1 ,versus(185.716±36.682)mg·L -1 , P <0.01].On the contrary, the activity of antithrombin Ⅲ was much lower than that in controls .On the contrary, the activity of antithrombin Ⅲ was much lower than that in controls ± s ,(97.06±23.47)%,versus(159.92±18.24)%, P <0.05].There was a significant difference of the ratio of AT Ⅲ:Ag to AT Ⅲ:Ac between the two groups .There was a significant difference of the ratio of AT Ⅲ:Ag to AT Ⅲ:Ac between the two groups ± s ,(7.399±1.237),versus(1.251±0.02), P <0.05].There was no significant difference in the antigen of protein C (PC) between the two groups .There was no significant difference in the antigen of protein C (PC) between the two groups ± s ,(2.749±0.962)mg·L -1 ,versus(3.271±0.664)?mg·L -1 ].The activity of plasmin was greater in the gallbladder bile of calculous patients than those of patients without gallstones .The activity of plasmin was greater in the gallbladder bile of calculous patients than those of patients without gallstones ± s ,(108.377±17.314)%,versus(32.778±8.552)%, P <0.05],and the ratio of fibrinolytic activity to coagulatic activity was much lower in patients with gallstones than in those without gallstones ,and the ratio of fibrinolytic activity to coagulatic activity was much lower in patients with gallstones than in those without gallstones ± s ,( 0.401± 0.096)%,versus(0.038±0.000?6)%, P <0.01].There was no significant difference in the activity of plasminogen activator inhibitor between the two groups .There was no significant difference in the activity of plasminogen activator inhibitor between the two groups ± s ,(0.442±0.036)%,versus(0.610±0.088)].D dimer was significantly higher in gallstones group than that in controls .D dimer was significantly higher in gallstones group than that in controls ± s ,(3.251±0.822)%,versus( 0.262± 0.025)%, P <0.01]. . Conclusion Both of the coagulatic activities and fibrinolytic activities in the bile of patients with gallstones are enhanced, but the anticoagulatic activities are not concomitantly enhanced and the increment of fibrinolytic activity w

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