Protein, Interleukin-6, Correlation Analysis Pneumoconiosis D- Dimer, Fibrinogen Significance And Reaction With C

Objective To detect levels of plasma D-dimer、fibrinogen and blood C reactive protein、serum interleukin6both in85pneumoconiosis patients at different stages and38controls,to apply anticoagulant therapy and observe the changes of above indexs in pneumoconiosis patients complicated with cor pulmonale before and after treatment, on purpose to study the change of thrombi function and the cilinical significance of dynamic detection of blood coagulation state in pneumoconiosis patients,to investigate further the correlation between thrombi function and excessive release of inflammatory mediators during the process of dust induced pulmonary fibrosis, to explore the clinical value of anticoagulant therapy in the treatment of pneumoconiosis.Methods85pneumoconiosis patients at different stages hospitalized in our hospital from October,2011to May,2013were enrolled:all patients were in stable states, without acute infection or trauma.The85patients including72silicosis patients、8carbon black pneumoconiosis、4founder’s pneumoconiosis and1asbestosis.All patients were males,the age37～79,the average age54.18±7.43; The85chosen patients including44stage I, the age37～61, the average age (52.4±6.0);21stageⅡ, the age43～74, the average age (56.2±8.9),20stage Ⅲ, the age42～79,the average age (56.1±8.3).Corresponding to wether with or without chronic cor pulmonale,85pneumoconiosis patients were subdivided into2groups:pneumoconiosis with chronic cor pulmonale(n=16),the age53-79,the average age (61.3±8.6); pneumoconiosis without chronic cor pulmonale (n=69),the age37～65,the average age(52.6±6.2);A11the pneumoconiosis patients had been dignosed by pneumoconiosis dignosis group in Weihai according to 《Dignostic Criteria of Pneumoconiosis》(GBZ70-2009),the dignosis of cor pulmonale was in accordance with the dignosis criteria of cor pulmonale which was revised in1980at the national third cor pulmonale professional meeting. All the patients were simultaneously without diabetes mellitus,cornary heart disease, hypertension,venous thromboembolism,the patients who used antiplatelet、anticoagulation drugs within three months were excluded either.38healthy individuals from physical examination were enrolled as controls,all were males,the age35～75, the average age (55.19±8.31).Levels of plasma D-dimer、fibrinogen、the blood C reactive protein and the serum interleukin6were measured both in pneumoconiosis patients at stage I, stageⅡ, stage Ⅲ and controls,the data were compared between these stages and groups respectively;for the pneumoconiosis group, the levels of CRP、IL-6were subjected to Pearson correlation analysis with plasma contents of D-dimer.For pneumoconiosis patients complicated with cor pulmonale, apply low molecular heparin(LMH) on the basis of conventional therapy and observe the changes of above indexs and blood gas index befor and after anticoagulant therapy.Results1. The levels of D-dimer and fibrinogen in85patients were significantly higher than those in the control group(p<0.01).2. The levels of D-dimer and fibrinogen in satge Ⅰ、Ⅱ and stage Ⅲ increased gradually,but there were no statistical difference between satgeⅠ、Ⅱ and stageⅢ respectively (p>0.05)3. Compared with non chronic cor pulmonale group,the plasma concentration of D-dimer and fibrinogen in group complicated with cor pulmonale was significantly higher(p<0.05).4. The levels of CRP and IL-6in pneumoconiosis patients were significantly higher compared with the control group(p<0.01).5. In pneumoconiosis group,there was positive correlation between the levels of D-dimer and IL-6(r=0.535,P<0.001),on the other hand, no significant difference was observed between the levels of D-dimer and CRP (r=0.144, p>0.05)6. After treatment with LMH in patients complicated with cor pulmonale, the levels of D-dimer and fibrinogen lower markedly than previous (p<0.05);the levels of CRP and IL-6decreased and the diffrences were statistically significant(p<0.05);the arterial partial pressure of oxygen elevated significantly,but no statistically diffrences of the arterial partial pressure of carbon dioxide were observed than before (p>0.05).Conclusions Levels of D-dimer and fibrinogen in pneumoconiosis patients were significantly higher compared with the control group,pneumoconiosis patients might be in a state of hypercoagulability.It seemed that the hypercoagulable state didn’t worsen with pneumoconiosis promotion,but in chronic cor pulmonale group,the levels of D-dimer and fibrinogen were obviously elevated which indicated hypercoagulability aggravated in patients who complicated with cor pulmonale. Through the study,we also found that the levels of IL-6、CRP in pneumoconiosis patients were significantly higher than those in controls especially in patients complicated with cor pulmonale,implying that there was excessive release of inflammatory mediators during the process of dust induced pulmonary fibrosis. Through correlation research, positive correlation was found between the levels of D-dimer and IL-6,indicating that the activation about zymoplastic system in pneumoconiosis patients might be related to the excessive release of IL-6during the dust induced fibrosis process. After the treatment with LMH in patients complicated with cor pulmonale, the levels of D-dimer and fibrinogen lower than previous,at the same time,the levels of CRP and IL-6decreased markedly and the arterial partial pressure of oxygen elevated significantly.To monitor blood coagulation state and timely use of anticoagulant agent in pneumoconiosis patients,especially in patients complicated with cor pulmonale might reduce the incidence of thrombi in small pulonary arteries and arterioles,thereby,lower pulmonary artery pressure and probably prevent or pospone the happening of cor pulmonale,what’s more,anticoagulation might reduce inflammation reaction,possibly prevent the occurrence and development of pulmonary fibrosis.