纤溶酶原激活物在诱因不明的顽固性鼻出血患者 中的表达及对近远期疗效的影响

The expression of plasminogen activator in unexplained refractory nasal bleeding and its influence on long-term treatment

摘要:

目的 探讨纤溶酶原激活物在诱因不明的顽固性鼻出血患者中的表达及对近远期疗效的影响。方法 分析2011年1月1日-2012年6月1日在该院接受治疗的顽固性鼻出血患者的临床资料。依据患者鼻出血原因分为两组，观察组：诱因不明；对照组：外伤性。结果 共纳入观察组62例，对照组51例。观察组治疗有效率显著低于对照组（83.87%，52/62 vs 96.08%，49/51；t =4.393，P =0.036）。观察组u-PAR、u-PA、TNF-α、IL-6及CRP均显著高于对照组，且u-PA与TNF-α及CRP呈现显著正相关（P <0.001）。术后1年，观察组有23（37.10%）例患者鼻出血复发。ROC曲线分析以首次鼻出血时患者u-PA水平预测术后1年鼻出血复发的截断点值为0.26，以u-PA为0.26μg/L为分界点将观察组患者分为A组（u-PA<0.26μg/L）、B组（u-PA≥0.26μg/L）。A组术后1年累积鼻出血复发率显著低于B组（5.88%，2/34 vs 75.00%，21/28；Log-rankχ2=31.460，P <0.001）。结论 诱因不明的顽固性鼻出血采用鼻内镜下止血效果差于外伤性顽固性鼻出血，纤溶功能亢进可能是降低其急救疗效及近、远期预后的因素之一。

Abstract:

【Objective】 To study the expression of plasminogen activator in unexplained refractory nasal bleeding and its influence on near nasal bleeding patients (Group A) and traumatic nasal bleeding (Group B) received and long-term curative efficacy. 【Methods】 Clinical data of unexplained refractory treatment at our hospital from 2011 to 2012 was retrospectively analyzed. 【Results】 There were 62 patents in Group A and 51 patients in Group B. Group A patients had a lower response rate than Group B (83.87%, 52/62 vs 96.08%, 49/51; t =4.393, P =0.036). Group A patients had a higher levels of u-PAR, u-PA, NF-α, IL-6 and CRP than Group B (P ＜0.05). Correlation analysis shown that u-PA had a significant positive correlation with TNF-α and CRP in Group A (P ＜0.001). ROC curve shown u-PA predicted postoperative recurrence of nasal bleeding 1 year after surgery had a cut-off point value of 0.26. Group A patients were divided into two groups, subgroup A (u-PA＜0.26μg/L) and subgroup B(u-PA≥0.26μg/L). The subgroup A patients had a lower recurrence rate than subgroup B (5.88%, 2/34 vs 75.00%,21/28; Log-rankχ2=31.460, P ＜0.001). 【Conclusion】 Unexplained refractory nasal bleeding had a lower response rate than traumatic nasal bleeding. Fibrinolysis hyperfunction may reduce the short-term and long-term treatment effects.