接受减肥手术的肥胖受试者的止血和纤维蛋白溶解变化：不同手术程序的影响。
Haemostatic and fibrinolytic changes in obese subjects undergoing bariatric surgery: the effect of different surgical procedures.
作者信息
Lupoli Roberta, Milone Marco, Di Minno Alessandro, Maietta Paola, Ambrosino Pasquale, Musella Mario, Di Minno Matteo N D
机构信息
Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
Department of Advanced Biomedical Science, Federico II University, Naples, Italy.
出版信息
Blood Transfus. 2015 Jul;13(3):442-7. doi: 10.2450/2014.0183-14. Epub 2014 Dec 16.
BACKGROUND
Little is known about effects of different bariatric surgery procedures on haemostatic and fibrinolytic parameters.
MATERIAL AND METHODS
Consecutive obese subjects undergoing gastric bypass (GBP) or sleeve gastrectomy (SG) were enrolled. In all patients, levels of haemostatic factors (FII, FVII, FVIII, FIX, FX, vWF, fibrinogen), fibrinolytic variables (PAI-1, t-PA and D-dimer) and natural anticoagulants (AT, protein C and protein S) were evaluated before and 2 months after surgery.
RESULTS
A total of 77 GBP and 79 SG subjects completed the study. At baseline no difference in coagulation parameters was found between the two groups. After both GBP and SG, subjects showed significant changes in haemostatic and fibrinolytic variables and in natural anticoagulant levels. The Δ% changes in FVII, FVIII, FIX, vWF, fibrinogen, D-dimer, protein C and protein S levels were significantly higher in subjects who underwent GBP than in those who underwent SG. Multivariate analysis confirmed that GBP was a predictor of higher Δ% changes in FVII (β=0.268, p=0.010), protein C (β=0.274, p=0.003) and protein S (β=0.297, p<0.001), but not in all the other variables. Following coagulation factor reduction, 31 subjects (25.9% of GBP and 13.9% of SG; p=0.044) showed overt FVII deficiency; protein C deficiency was reported by 34 subjects (32.5% of GBP vs 11.4% of SG, p=0.033) and protein S deficiency by 39 (37.6% of GBP vs 12.6% of SG, p=0.009). Multivariate analyses showed that GBP was associated with an increased risk of deficiency of FVII (OR: 3.64; 95% CI: 1.73-7.64, p=0.001), protein C (OR: 4.319; 95% CI: 1.33-13.9, p=0.015) and protein S (OR: 5.50; 95% CI: 1.71-17.7, p=0.004).
DISCUSSION
GBP is associated with an increased risk of post-operative deficiency in some vitamin K-dependent coagulation factors. Whereas such deficiency is too weak to cause bleeding, it is significant enough to increase the risk of thrombosis.
背景
关于不同减肥手术程序对止血和纤溶参数的影响，人们了解甚少。
材料与方法
纳入连续接受胃旁路手术（GBP）或袖状胃切除术（SG）的肥胖受试者。在所有患者中，于手术前及术后2个月评估止血因子（FII、FVII、FVIII、FIX、FX、vWF、纤维蛋白原）、纤溶变量（PAI-1、t-PA和D-二聚体）及天然抗凝剂（抗凝血酶III、蛋白C和蛋白S）水平。
结果
共有77例接受GBP手术和79例接受SG手术的受试者完成了研究。基线时，两组的凝血参数无差异。GBP和SG手术后，受试者的止血和纤溶变量以及天然抗凝剂水平均出现显著变化。接受GBP手术的受试者FVII、FVIII、FIX、vWF、纤维蛋白原、D-二聚体、蛋白C和蛋白S水平的Δ%变化显著高于接受SG手术的受试者。多因素分析证实，GBP是FVII（β=0.268，p=0.010）、蛋白C（β=0.274，p=0.003）和蛋白S（β=0.297，p<0.001）的Δ%变化较高的预测因素，但对所有其他变量并非如此。在凝血因子降低后，31名受试者（GBP组的25.9%和SG组的13.9%；p=0.044）出现明显的FVII缺乏；34名受试者（GBP组的32.5%对SG组的11.4%，p=0.033）报告有蛋白C缺乏，39名受试者（GBP组的37.6%对SG组的12.6%，p=0.009）有蛋白S缺乏。多因素分析显示，GBP与FVII缺乏风险增加相关（OR：3.64；95%CI：1.73 - 7.64，p=0.001）、蛋白C缺乏风险增加相关（OR：4.319；95%CI：1.33 - 13.9，p=0.015）和蛋白S缺乏风险增加相关（OR：5.50；95%CI：1.71 - 17.7，p=0.004）。
讨论
GBP与术后某些维生素K依赖的凝血因子缺乏风险增加相关。虽然这种缺乏程度较弱不足以导致出血，但足以增加血栓形成的风险。
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