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目的探讨严重急性呼吸综合征(SARS)后骨坏死的病因学,以便用于非创伤性骨坏死的早期诊断和易感人群的筛选。方法取61例SARS后骨坏死患者空腹肘静脉血。另取健康人群52名为对照,应用酶联免疫吸附法等试验定凝血、纤溶指标,应用实时聚合酶链反应(PCR)仪测定因子V G1691A(FV Le iden)变、凝血酶原G20210A突变。结果SARS后骨坏死患者血液学因素改变明显,其中蛋白C(PC)、活化蛋白C抵抗(APC-R)、抗凝血酶Ⅲ(AT-Ⅲ)、纤溶酶原激活抑制物(PAI)、纤溶酶原(PLG)。两组比较,差异有统计学意义(109%±20%vs 85%±34%、8.0 U/m l±4.3U/m l、16 U/m l±14 U/m l、197 s±46 s vs 192 s±63 s、104%±14%vs 84%±29%、94%±15%vs69μ/m l±23μ/m l,P<0.01)。骨坏死组和对照组均未发现因子V Le iden突变和凝血酶原G20210A的突变。结论SARS后骨坏死患者存在高凝低纤溶倾向,对骨坏死易感人群可以进行高凝和低纤溶指标的筛选,PC、AT-Ⅲ、PAI、APC-R、PLG可作为骨坏死易感因素的筛选指标。SARS后骨坏死与因子V Le iden和凝血酶原G20210A突变无关。
Objective To investigate the etiology of osteonecrosis after severe acute respiratory syndrome (SARS) for early diagnosis of non-invasive osteonecrosis and screening of susceptible populations. Methods Fasting elbow vein blood was collected from 61 patients with post-SARS osteonecrosis. Another 52 healthy people as a control, the application of enzyme-linked immunosorbent assay coagulation, fibrinolysis indicators, real-time polymerase chain reaction (PCR) determination of factor V G1691A (FV Le iden) change, prothrombin G20210A mutation . Results The hematological factors of patients with post-SARS were significantly changed. Among them, protein C (PC), APC-R, AT-Ⅲ, PAI, , Plasminogen (PLG). The difference between the two groups was statistically significant (109% ± 20% vs 85% ± 34%, 8.0 U / ml ± 4.3 U / ml, 16 U / ml ± 14 U / ml, 197 s ± 46 s vs 192 s ± 63 s, 104% ± 14% vs 84% ± 29%, 94% ± 15% vs 69 μ / ml ± 23 μ / ml, P <0.01). Neither the V Le iden mutation nor the prothrombin G20210A mutation were found in the osteonecrosis group and the control group. Conclusions There is a tendency of hypercoagulability and fibrinolysis in patients with post-SARS osteosarcoma, and high, low fibrinolytic indexes can be screened in susceptible people with osteonecrosis. PC, AT-Ⅲ, PAI, APC-R and PLG can be used as osteonecrosis Sensory factors of screening indicators. Osteonecrosis after SARS was not associated with factor V Le iden and prothrombin G20210A mutation.