2022 年第 6 期 第 17 卷

全关节置换术患者围术期血浆硫化氢和一氧化氮浓度变化趋势及其参与抗凝的机制探讨

Changes of hydrogen sulfide and nitric oxide in the perioperative period of total joint arthroplasty and those mechanism in anticoagulation

作者：王振华王聪赵斌刘志伟

英文作者：Wang Zhenhua Wang Cong Zhao Bin Liu Zhiwei

单位：北京积水潭医院急诊科，北京100035

英文单位：

关键词：全关节置换术；硫化氢；一氧化氮；纤溶功能；血管内皮功能

英文关键词：Totaljointarthroplasty；Hydrogensulfide；Nitricoxide；Fibrinolyticfunction；Vascularendothelialfunction

• 摘要：

• 目的 观察全关节置换术（TJA)患者围术期血浆气体分子硫化氢和一氧化氮以及纤溶功能和内皮损伤相关指标的变化趋势，并对指标间相互影响的机制进行初步探讨。方法 选取北京积水潭医院2018年3月1日至6月30日接受TJA患者119例。收集患者临床资料，所有患者分别在术前1 d及术后24、72 h采用酶联免疫吸附试验法检测血浆硫化氢、一氧化氮以及纤溶功能和内皮损伤相关指标组织纤溶酶原激活物（t-PA）、可溶性血小板内皮细胞黏附分子1（sPECAM-1）浓度。结果 术前、术后24 h及术后72 h患者血浆硫化氢浓度分别为（0.07±0.04）、（0.09±0.08）、（0.13±0.05）ng/L，一氧化氮浓度分别为（33±13）、（38±13）、（51±18）μmol/L，t-PA浓度分别为（2.0±1.0）、（2.5±0.9）、（2.9±0.8）μg/L，sPECAM-1浓度分别为（69±26）、（106±38）、（156±43）μg/L。血浆硫化氢、一氧化氮、t-PA及sPECAM-1浓度均进行性升高，不同时点间两两比较差异均有统计学意义（均P＜0.05）。术前及术后72 h，硫化氢、一氧化氮均与t-PA、sPECAM-1呈正相关（均P＜0.001）。结论 TJA患者围术期体内硫化氢和一氧化氮水平呈显著上升趋势，且可能存在协同促进的相互影响。TJA患者围术期可能出现血管内皮细胞功能受损及纤溶系统活化，表现为t-PA及sPECAM-1的表达增加，而气体分子硫化氢和一氧化氮可能参与到这一活化机制的某一环节中从而产生抗血栓作用。

• Objective To observe the dynamic change of plasma gas molecules ［hydrogen sulfide (H2S) and nitric oxide (NO)］, coagulation-fibrinolytic function and endothelial injury related indicators in patients undergoing total joint arthroplasty (TJA) and to discuss the mechanism of the mutual influence among the indexes. Methods Totally 119 patients undergoing TJA were included in Beijing Jishuitan Hospital from March 1 to June 30 in 2018. The clinical data of all patients were collected. The concentrations of plasma H2S, NO, tissue plasminogen activator (t-PA) and soluble platelet endothelial cell adhesion molecule-1 (sPECAM-1) were detected by enzyme-linked immunosorbent assay 1 d before operation and 24 and 72 h after operation. Results   The plasma H2S concentrations were （0.07±0.04）,（0.09±0.08）,（0.13±0.05）ng/L, NO concentrations were （33±13）,（38±13）,（51±18）μmol/L, t-PA concentrations were （2.0±1.0）,（2.5±0.9）,（2.9±0.8）μg/L, and sPECAM-1 concentrations were （69±26）,（106±38）,（156±43）μg/L before operation and 24 and 72 h after operation, respectively. The plasma concentrations of H2S, NO, t-PA and sPECAM-1 increased gradually, and there were significant differences among different time points (all P＜0.05). H2S and NO were positively correlated with t-PA and sPECAM-1 before operation and 72 h after operation (all P＜0.001). Conclusions  During the perioperative period, the levels of H2S and NO in TJA patients increase significantly, and there may be a synergistic interaction between them. During the perioperative period, the function of vascular endothelial cells may be damaged and the fibrinolytic system may be activated, which are manifested by the increased expression of t-PA and sPECAM-1, and the gas molecules H2S and NO may participate in a certain link of this activation mechanism, resulting in antithrombotic effect.