A Study Of The Relationship Between Coagulation/Anticoagulation Imbalance And Oxidative Stress In The Patients With Chronic Obstructive Pulmonary Disease.

Objective To observe the change of oxidative stress and the level of tissue factor (TF) activity, tissue factor pathway inhibitor (TFPI) activity, and their ratio (TF/TFPI) of plasma in the patients with chronic obstructive pulmonary disease during acute exacerbation (AECOPD) before and after treatment. To explore the relationship between coagulation/anticoagulation imbalance and oxidative stress in AECOPD patients before and after treatment.Methods TF activity and TFPI activity of plasma were detected by chromogenic assay in 28 AECOPD patients before and after treatment and in 30 healthy persons. The total antioxidative capacity (TAC) in plasma was measured by o-phenanthroline colorimetric analysis. The content of malondialdehyde (MDA) in plasma was measured by thiobarbituricacid colorimetric analysis. The glutathione peroxidase (GSH-PX) in plasma was detected by 5,5'-dithiobis- 2- nitrobenzoic acid (DNTB) method. The prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) in plasma were detected by Nephelometry. The respiratory function were measured by lung function, arterial blood gas testing and modified medical research council dyspnea scal (MMRC) respectively in AECOPD patients before and after treatment.Results 1. The indexes associated with respiratory function:1.1 The lung function in AECOPD patients before treatment [FEV1%(40.64±17.14)%, FEV1/FVC%(47.09±11.55)%] was significantly lower than that after treatment [FEV1%(52.16±24.07)%, FEV1/FVC% (53.93±13.66)%] (P all<0.05) respectively, but they were all still lower than that in healthy persons[FEV1%(104.10±14.73)%,FEV1/FVC%(81.03±7.00)%] (P all<0.01).1.2 The level of PaO2 and SaO2% in AECOPD patients before treatment [(47.32±8.81) mmHg, (81.54±10.83)%] was significantly lower than that after treatment [(55.48±7.11)mmHg, (88.61±4.10)%] (P all< 0.01) respectively, but there was no statistical difference of PaCO2 in AECOPD patients before (41.89±8.76) mmHg and after (41.17±8.73) mmHg treatment (P>0.05).1.3 The percentage of neutrophils in AECOPD patients before treatment (69.05±10.80)% was significantly higher than that after treatment (61.67±8.33)% and that in healthy persons (58.12±7.26)%(P<0.01 or< 0.05) respectively, but there was no statistical difference of the percentage of neutrophils in AECOPD patients after treatment and in healthy persons (P>0.05).1.4 The dyspnea scale in AECOPD patients before treatment (2.86±0.45) was significantly higher than that after traetment (1.43±0.50) (P<0.01) respectively.2. The indexes associated with coagulation function:2.1 The levels of plasma TF activity in AECOPD patients before treatment (139.32±81.93) pmol/L was significantly higher than that after treatment (36.35±14.94) pmol/L (P<0.01). Although they showed decreased after treatment, but they were all still higher than that in the healthy persons (3.34±3.26) pmol/L (P all<0.01).2.2 The levels of plasma TFPI activity in AECOPD patients before treatment (0.11±0.02) U/ml was significantly higher than that after treatment (0.09±0.01) U/ml (P<0.01). Although they showed decreased after treatment, but they were all still higher than that in the healthy persons (0.06±0.01) U/ml (P all<0.01).2.3 The levels of TF/TFPI in AECOPD patients before treatment (1204.52±531.06) was significantly higher than that after treatment (399.93±130.35) (P<0.01). Although they showed decreased after treatment, but they were all still higher than that in the healthy persons (52.70±48.15) (P all<0.01).2.4 Both the levels of plasma PT, APTT and FIB in AECOPD patients before [(15.13±4.64) s, (31.61±9.45) s, (5.09±2.05) g/L] and after [(14.58±3.89) s, (30.28±5.87) s, (5.10±1.66) g/L] treatment were higher than that in the healthy persons [(13.09±1.06) s, (27.88±2.74)s, (3.93±1.01) g/L] (P all<0.05), but there was no statistical difference in AECOPD patients before and after treatment (P all>0.05).3. The degree of oxidative stress:3.1 The level of plasma TAC in AECOPD patients before treatment (3.35±0.54) U/ml was significantly lower than that after treatment (3.76±0.31) U/ml (P <0.01). Although the plasma TAC showed increased after treatment, but they were all still lower than that in the healthy persons (4.15±0.26) U/ml (P all<0.01).3.2 The level of plasma MDA in AECOPD patients before treatment (12.18±2.50) nmol/ml was significantly higher than that after treatment (9.56±2.15) nmol/ml (P<0.01). Although the plasma MDA showed decreased after treatment, but they were all still higher than that in the healthy persons (8.49±1.21) nmol/ml (P< 0.01 or<0.05).3.3 The level of plasma GSH-PX in AECOPD patients before treatment (146.65±25.89) U/ml was significantly lower than that after treatment (207.18±20.31) U/ml (P< 0.01). Although the plasma GSH-PX showed increased after treatment, but they were all still lower than that in the healthy persons (224.77±24.01) U/ml (P all<0.01).4. The correlations between coagulation/anticoagulation imbalance and oxidative stress:4.1 There were negative correlations between the ratio of TF/TFPI and TAC,GSH-PX,PaO2 respectively (P<0.01 or<0.05) and a positive correlation between the ratio of TF/TFPI and the percentage of neutrophils (P<0.05) in AECOPD patients before treatment.4.2 There still were negative correlations between the ratio of TF/TFPI and TAC,FEV1% respectively [P all<0.05), and a positive correlation between the ratio of TF/TFPI and MDA (P< 0.05) in AECOPD patients after treatment.Conclusion AECOPD patients always showed that there were coagulation/anticoagulation imbalance and oxidation/antioxidation imbalance before and after treatment, and they were always improved after treatment. The relationship between coagulation/anticoagulation imbalance and oxidation/antioxidation imbalance was existed in AECOPD patients, and they were correlate with severity of disease, hypoxia and infection.