中华皮肤科杂志 ›› 2008, Vol. 41 ›› Issue (8): 519-521.

• 论著 • 上一篇    下一篇

银屑病患者血管内皮及凝血、抗凝血功能变化的观察

孙小强 王璐 门剑龙 周之海   

  1. 天津医科大学总医院 天津医科大学总医院临床检验科 天津医科大学总医院皮肤科
  • 收稿日期:2007-10-30 修回日期:2008-02-22 发布日期:2008-08-15
  • 通讯作者: 孙小强 E-mail:sun20052324@sohu.com

Vascular endothelial damage as well as changes in coagulation and anticoagulation function in psoriatic patients

SUN Xiao-Qiang   

  • Received:2007-10-30 Revised:2008-02-22 Published:2008-08-15
  • Contact: SUN Xiao-Qiang E-mail:sun20052324@sohu.com

PDF

121

摘要： 目的 通过研究银屑病患者血管内皮细胞的损伤情况和抗凝血、凝血功能参数的改变来探讨其与病程发展的关系。方法 采用IL ACL 9000型血液凝固仪测定51例寻常性银屑病患者和50例健康体检者的血管内皮细胞、凝血及抗凝血系统的各项指标，并结合PASI分值进行分析。结果 银屑病进行期患者组抗凝血酶活性为69.2％ ± 17.3％、蛋白C活性为80.4％ ± 17.3％、蛋白C抗原含量为74.1％ ± 23.8％，静止期患者组分别为84.6％ ± 11.9％、93.1％ ± 15.5％、95.2％ ± 18.3％，均低于正常人对照组（分别为102.0％ ± 21.3％、107.4％ ± 17.2％、103.2％ ± 12.7％）。进行期纤溶酶原激活物抑制剂－1水平为（1.4 ± 0.7） Au/L、vW因子为200.8％ ± 35.3％，静止期分别为（0.9 ± 0.6） Au/L）、141.6％ ± 59.1％，与正常人对照组比较，差异均有统计学意义（P < 0.01）。进行期患者vW因子水平高于静止期，抗凝血酶活性、蛋白C活性水平低于静止期，差异均有统计学意义（P < 0.01）。20例进行期银屑病患者治疗后的抗凝血酶活性（79.5％ ± 13.0％）、蛋白C活性（87.6％ ± 10.9％）、蛋白C抗原含量（86.9％ ± 20.5％）水平高于治疗前，纤溶酶原激活物抑制剂－1（1.0 ± 0.86 Au/L）和vW因子（172.8％ ± 44.5％）低于治疗前，差异均有统计学意义（P < 0.01）。进行期银屑病患者凝血因子Ⅷ活性（156.2％ ± 67.1％）高于静止期（129.4％ ± 33.2％）和正常人对照组（101.0％ ± 19.8％），静止期患者高于正常人对照组，差异均有统计学意义（P < 0.01）。20例进行期银屑病患者治疗前后PASI分值差异无统计学意义（P > 0.05），PASI分值与各项指标间亦无显著相关性（P > 0.05）。结论 银屑病患者存在显著的内皮细胞损伤，这种损伤导致抗凝血和纤溶系统功能降低，且抗凝血和纤溶的异常与病程密切相关。

关键词: 银屑病, 凝血, 抗凝血, 内皮

Abstract: Objective To study the vascular endothelial damage and changes in parameters related to coagulation and anticoagulation function in patients with psoriasis, and to investigate their relationship to the development of psoriasis. Methods A total of 51 patients with psoriasis （29 at active stage and 22 at stable stage） were enrolled into this study, along with 50 normal controls. Twenty patients with active psoriasis received treatment with daily introvenous Danshen injection, topical triamcinolone acetonide cream as well as oral clarithromycin when necessary. Coagulation analyzer ACL 9000 was used to measure the parameters related to endothelial damage, coagulation and anticoagulation system in these patients and controls. Psoriasis area and severity index （PASI） was used to evaluate these patients before and after the treatment. The correlation between PASI and the tested parameters was assessed. Results Compared with the normal controls, decreased antithrombin activity as well as protein C activity and antigen were observed in patients at active stage ( 69.2％ ± 17.3％, 80.4％ ± 17.3％, 74.1％ ± 23.8％ respectively） and in those at stable stage （84.6％ ± 11.9％, 93.1％ ± 15.5％, 95.2％ ± 18.3％ respectively）, whereas increased levels of plasminogen activator inhibitor-1 and vW factor were found in active psoriatic patients （0.6 ± 0.5 Au/L, 100.7％ ± 25.6％ respectively） and in stable psoriatic patients （0.9 ± 0.6 Au/L, 141.6％ ± 59.1％ respectively）. Patients with active psoriasis had a higher level of vW factor but a lower level of antithrombin and protein C activity than those with stable psoriasis （all P < 0.01）. After treatment, the levels of antithrombin activity as well as protein C activity and antigen in patients with active psoriasis increased to 79.5％±13.0％, 87.6％ ± 10.9％, 86.9％ ± 20.5％ respectively, while the level of plasminogen activator inhibitor-1 and vW factor decreased to 1.0 ± 0.86 Au/L and 172.8％ ± 44.5％ respectively （all P < 0.01）. The activity of blood coagulation factor Ⅷ was lower in patients with stable psoriasis than in those with active psoriasis （129.4％ ± 33.2％ vs 156.2％ ± 67.1％, P < 0.01） but higher than in the normal controls （P < 0.01）. No significant difference was noticed in PASI before and after the treatment, and there was no correlation between PASI and any of the tested parameters. Conclusions There is an apparent damage to endothelial cells in psoriatic patients, which may lead to the attenuation of anticoagulation function and fibrinolysis activity. Also, the abnormality in anticoagulation and fibrinolysis system is closely related to the development of psoriasis.

Key words: psoriasis, coagulation system, anticoagulation system, endothelium