【摘要】：潰瘍性結(jié)腸炎(ulcerative colitis,UC)是一種病因和發(fā)病機制尚不明確的慢性非特異性炎癥,以反復發(fā)作的腹痛、腹瀉、粘液膿血便為主要臨床表現(xiàn)。近年來,研究發(fā)現(xiàn)UC患者常處于高凝狀態(tài),易并發(fā)血栓栓塞性疾病,且多為無癥狀性血栓,對UC患者存在潛在的威脅,血栓栓塞已成為導致潰瘍性結(jié)腸炎患者死亡的原因之一,越來越引起人們的關注。潰瘍性結(jié)腸炎血栓形成的機制非常復雜,目前尚未明確,多數(shù)研究認為UC患者高凝狀態(tài)、血栓栓塞的發(fā)展通過影響其凝血機制而實現(xiàn),是獲得性和遺傳性風險因素之間相互作用的結(jié)果,UC患者凝血功能紊亂主要包括血小板功能障礙、內(nèi)皮細胞受損、凝血系統(tǒng)異常、纖溶系統(tǒng)受破壞和免疫功能異常等系統(tǒng)變化,這些風險因素在血栓形成之前已發(fā)生相關變化。因此,對UC患者凝血功能相關指標進行有效監(jiān)測,通過加強對住院患者或存在血栓風險病人的管理,可改善UC患者的高凝狀態(tài),有效預防血栓的發(fā)生,降低病死率,提高患者生活質(zhì)量,為UC治療提供新的臨床思路和研究方向。凝血功能相關指標在UC發(fā)病機制及并發(fā)血栓栓塞風險中的作用尚未明確,有待進一步試驗研究闡明。本實驗探討UC患者血小板計數(shù)、平均血小板體積、P-選擇素表達、同型半胱氨酸、凝血因子Ⅴ、凝血因子Ⅷ、D-二聚體、抗心磷脂抗體水平變化。目的:檢測UC患者凝血功能相關指標的變化,探討其是否與UC患者高凝狀態(tài)及UC嚴重程度相關。方法:1選取2016年1月至2017年1月在河北醫(yī)科大學第二醫(yī)院確診為UC活動期患者29例作為實驗組,并按照改良Mayo評分將其分為輕度、中度、重度三組,輕度10例、中度7例、重度12例。結(jié)腸息肉患者11例作為對照組。2檢測實驗組及對照組外周血血小板計數(shù)、平均血小板體積、P-選擇素表達、同型半胱氨酸、凝血因子Ⅴ、凝血因子Ⅷ、D-二聚體、抗心磷脂抗體水平。應用SPSS13.0采用方差分析對數(shù)據(jù)進行統(tǒng)計學分析。3結(jié)腸鏡下選取直-乙交界處結(jié)腸黏膜2塊,采用HE染色顯微鏡下觀察結(jié)腸粘膜組織病理學表現(xiàn),免疫組化方法檢測結(jié)腸粘膜P-選擇素表達情況。應用SPSS21.0采用χ2檢驗對數(shù)據(jù)進行統(tǒng)計學分析。結(jié)果:1外周血結(jié)果UC患者PLT計數(shù)、P-選擇素、同型半胱氨酸、凝血因子Ⅷ、D-二聚體顯著高于對照組(P0.05),差異有統(tǒng)計學意義;平均血小板體積(mean platelet volume,MPV)、凝血因子Ⅴ顯著低于對照組(P0.05),差異有統(tǒng)計學意義;抗心磷脂抗體(anticardiolipin antibody,ACA)陽性率顯著高于對照組。PLT計數(shù)為重度中度輕度對照組,任意兩組比較,差異有統(tǒng)計學意義(P0.05);同型半胱氨酸水平為重度顯著高于輕度和中度(P0.05);凝血因子Ⅷ水平為重度顯著高于輕度(P0.05);D-二聚體水平為重度和中度顯著高于輕度(P0.05);P-選擇素、MPV、凝血因子Ⅴ水平任意兩組間比較,差異無統(tǒng)計學意義(P0.05);2 HE染色結(jié)果對照組結(jié)腸黏膜上皮結(jié)構完整,腺體細胞排列整齊,杯狀細胞較多,可見少量炎性細胞浸潤;UC各組黏膜上皮脫落或缺失,可見大量炎性細胞浸潤,腺體變形、排列紊亂、數(shù)目減少,隱窩結(jié)構紊亂,隱窩內(nèi)及隱窩上皮均可見大量中性粒細胞浸潤,伴杯狀細胞減少;3免疫組織化學染色檢測結(jié)腸粘膜組織中p-選擇素的表達UC患者結(jié)腸粘膜中P-選擇素表達較對照組增加,具有統(tǒng)計學意義(P0.05),P-選擇素陽性染色率重度83.33%(10/12)中度57.14%(4/7)輕度30%(3/10),各組之間差別有統(tǒng)計學意義(P0.05)。結(jié)論:1活動期UC患者處于高凝狀態(tài),存在凝血功能紊亂,主要與血小板功能障礙、內(nèi)皮細胞受損、凝血系統(tǒng)異常、纖溶系統(tǒng)受破壞和免疫功能異常相關。2活動期UC患者PLT計數(shù)、P-選擇素、同型半胱氨酸、凝血因子Ⅷ、D-二聚體明顯升高,凝血因子Ⅴ、MPV明顯降低,ACA陽性率增加,對監(jiān)測機體高凝狀態(tài)具有重要作用,是預防血栓形成的有效臨床指標。3活動期UC患者PLT計數(shù)、結(jié)腸粘膜組織中P-選擇素表達與疾病嚴重程度相關。
[Abstract]:Ulcerative colitis (UC) is a kind of chronic non-specific inflammation which is not clear in the pathogenesis and pathogenesis, and is the main clinical manifestation of recurrent abdominal pain, diarrhea, and mucus. In recent years, it has been found that UC patients are often in hypercoagulable state, easy to be concurrent with thromboembolic diseases, and are not asymptomatic, and there is a potential threat to UC patients. Thromboembolism has become one of the causes leading to the death of patients with ulcerative colitis, and more and more attention has been paid to. The mechanism of the formation of ulcerative colitis is very complex and is not yet clear, most of which are considered to be hypercoagulable in patients with UC, and the development of thromboembolism is achieved by influencing its clotting mechanism, as a result of the interaction between acquired and inherited risk factors, Coagulation dysfunction in patients with UC mainly includes such system changes as platelet dysfunction, impaired endothelial cell, abnormal blood coagulation system, disruption of the fibrinolytic system and abnormal immune function, and these risk factors have changed before the formation of the thrombus. Therefore, the blood coagulation function related index of the UC patient is effectively monitored, the high-setting state of the UC patient can be improved, the occurrence of the thrombus is effectively prevented, the fatality rate is reduced, the quality of life of the patient is improved, And provides a new clinical thought and a research direction for the treatment of UC. The role of coagulation-related index in the pathogenesis of UC and the risk of concurrent thromboembolic events is not clear, and the study is to be further tested and clarified. The platelet count, mean platelet volume, P-selectin expression, homocysteine, coagulation factor V, factor VIII, D-dimer and anticardiolipin antibody level were discussed in this experiment. Objective: To investigate the changes of coagulation function in patients with UC and to explore whether it is related to the hypercoagulability and the severity of UC in patients with UC. Methods: From January 2016 to January 2017,29 patients with active UC were identified as experimental group and the modified Mayo score was divided into mild, moderate, severe three groups, mild in 10, moderate in 7, and severe in 12 cases. The peripheral blood platelet count, mean platelet volume, P-selectin expression, homocysteine, coagulation factor V, factor VIII, D-dimer and anticardiolipin antibody level in the peripheral blood of the experimental group and the control group were measured. The data were analyzed by means of analysis of variance with SPSS 13.0. Two blocks of colon mucosa at the junction of straight-B were selected under the colonoscope. The pathological manifestations of the colonic mucosa were observed by HE staining. The expression of P-selectin in the colon mucosa was detected by immunohistochemistry. Statistical analysis of the data was performed using the SPSS21.0 using the Sup2 test. Results: The level of PLT, P-selectin, homocysteine, factor VIII and D-dimer in peripheral blood of patients with UC were significantly higher than that in the control group (P0.05). The mean platelet volume (MPV) and coagulation factor V were significantly lower than that in the control group (P0.05). The positive rate of anticardiolipin antibody (ACA) was significantly higher than that of the control group. The level of blood coagulation factor 鈪，

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