蛇毒血凝酶在肺癌根治术中的止血效果分析及其对凝血酶受体-1的影响

摘要

目的：探讨蛇毒血凝酶在肺癌根治术中的止血效果及其对凝血酶受体-1（protease-activated receptor-1，PAR-1）的影响。方法选取86例经病理证实为肺癌患者，随机分为观察组和对照组，其中对照组采用止血敏，观察组采用蛇毒血凝酶，分别在手术前后测定出血量，凝血系统相关因子，采用酶联免疫吸附实验（enzyme linked immuno sorbent assay，ELISA）测定P-选择素，流式细胞术测定血小板PAR-1，Western blot测定肺癌组织中PAR-1的表达情况，对所得数据采用统计学分析。结果观察组在术中及术后2d出血量，显著低于对照组，差异具有统计学差异（P＜0.05）；流式细胞术检测结果发现，观察组中组内不同时间段PAR-1阳性率及P-选择素无统计学意义，同对照组相比具有统计学意义（P＜0.05）；Western Blot检测发现蛇毒血凝酶对肺癌患者组织中PAR-1影响不明显，而对照组具有统计学差异义（P＜0.05）。结论蛇毒血凝酶在肺癌根治术中可以减少出血量，对凝血系统作用较为稳定，对P-选择素和PAR-1影响较小，这一结果提示蛇毒血凝酶可能在肺癌根治术患者止血过程中不会使患者出现全身血液高凝状态，即不会导致凝血酶受体高表达从而引起的肿瘤细胞转移。%Objective To investigate hemocoagulase hemostatic effect in lung cancer radical surgery and its effect on protease-activated receptor-1 (PAR-1 ).Methods 86 cases of pathologically confirmed lung cancer patients were randomly divided into control group and observation group,which controls were used etamsylate,observation group were used hemocoagulase,then to measure the amount of bleeding,clotting system-related factors before and after surgery,using ELISA assay to detect P-selectin,flow cytometry to measure platelet PAR-1 ,Western Blot to determine lung tissue expression of PAR-1,and the resulting data were statistically analyzed. Results The blood loss of observation group during surgery and postoperative 2d compared with the control group,had a significant difference (P<0.05 );flow cytometry results showed that,PAR-1-positive rate and P-selectin in different time periods in observation group were no statistically significant,while had a statistically significant compared with control group(P<0.05 );Western Blot detected hemocoagulase of lung tissue in patients with PAR-1 had no obvious effect,while control group had significant difference (P<0.05).Conclusion Venin hemocoagulase in lung cancer radical surgery can reduce the amount of bleeding,and be more stable for the role of the coagulation system,as well as less effect on the P-selectin and PAR-1.The results suggest that vonin hemocoagulase might not make patients with systemic hypercoagulable state in patients undergoing radical process with lung cancer,in other words it might not lead to PAR-1 highly expression to cause tumor cell metastasis.