易栓症及其实验室筛查项目的应用现状.docxVIP

易栓症及其实验室筛查项目的应用现状ABSTRACT:Thrombophilia is not a specific clinical disease, but a state of high blood coagulation, which is caused by the lack of hereditary or acquired anticoagulant protein, coagulation factor and fibrinolytic protein. It is divided into two kinds: genetic and acquired, but in recent years, it has been found that the influence of the two factors can be cross. In genetic susceptibility to thrombosis, the formation of the East and West Ethnic genetic factors are not the same. In the acquired disease, age, pregnancy, large operation, long time to stay in bed, malignant tumor, hyperhomocysteinemia, smoking can lead to easy to bolt. At present, thrombophilia screening laboratory tests including antithrombin, protein C and protein S activity and plasma homocysteine (Hcy), activated protein C resistance and MTHFR mutation of C677T, factor VII, VIII, IX and Xi, there is a decrease of anticoagulant protein activity was measured the level of individual, should have a related antigen a clear, the type of deficiency of anticoagulant proteins.KEY WORDS:Thrombophilia;laboratory examination; ProteinC;ProteinS ;AT-Ⅲ;摘要：易栓症不是一种特定的临床疾病，而是由于遗传性或获得性的抗凝蛋白、凝血因子、纤溶蛋白等缺乏导致的一种血液高凝的状态。易栓症分为遗传性和获得性两种，但近年发现两类因素可有交叉影响。在遗传性易栓症中，东西方人种形成易栓症的遗传因素并不相同。在获得性易栓症中，年龄、怀孕、大型手术术后、卧床时间长、恶性肿瘤、高同型半胱氨酸血症、吸烟等可导致易栓症。目前易栓症实验室筛查的检测项目包括抗凝血酶Ⅲ、蛋白C和蛋白S的活性、同型半胱氨酸（Hcy）、活化蛋白C抵抗及MTHFR C677T突变、凝血因子Ⅶ、Ⅷ、Ⅸ、Ⅺ等，存在抗凝蛋白活性下降的个体，有条件时应进行相关抗原水平的测定，明确抗凝蛋白缺陷的类型。关键词：易栓症；实验室检查；蛋白C；蛋白S；抗凝血酶Ⅲ；1865年法国Armand Trousseau教授首次报道静脉血栓与肿瘤之间存在联系这可能是人们对易栓症(thrombophlilia)的最早认识。易栓症不是单一疾病，而是指由于抗凝蛋白、凝血因子、纤溶蛋白等的遗传性或获得性缺陷或存在获得性危险因素而容易发生血栓栓塞的疾病或状态,易栓症的血栓栓塞类型主要为静脉血栓栓塞症(VTE)。1．易栓症的类型:易栓症分为遗传性易栓症和获得性易栓症两类。常见的遗传性易栓症有：蛋白c(Pc)缺陷症、蛋白s(PS)缺陷症、抗凝血酶(AT)缺陷症、因子VIJeiden(FV Leiden)和凝血酶原20210A突变；纤溶蛋白缺陷：异常纤溶酶原血症、组织型纤溶酶原激活物(t-PA)缺陷症、纤溶酶原活化抑制物一1(PAI一1)增多；代谢缺陷：高同型半胱氨酸血症(MTHFR突变)；凝血因子水平升高：因子Ⅷ、Ⅸ或Ⅺ活性水平升高等[1]。获得性易栓症：有些是容易引发血栓的疾病，如抗磷脂综合征、肿瘤、骨髓增殖性肿瘤、阵发性睡眠性血红蛋白尿症、肾病综合征、急性内科疾病(充血性心力衰竭、严重呼吸疾病等)、炎性肠病等，还有一些则是易发生血栓的危险状态，如制动、创伤、手术、以及高龄妊娠及产褥期、口服避孕药及激素替代治疗、肿瘤治疗、获得性抗凝蛋白缺陷等[