Changes Of Molecular Markers Of The Coagulation And Fibrinolysis In Patients With Hyperlipidemia During LC And Its Clinical Function

OBJECTIVE:In order to investigate changes of coagulation and fibrinolysis in patients during laparoscopic cholecystectomy(LC).Its influence upon coagulation and fibrinolysis whether patients with hyperlipidemia who have a tendency to thrombotic risk might indicate a higher risk of postoperative thromboembolic complications.This study evaluate not only security of LC but also necessity of thrombo- prophylaxis after laparoscopic surgery were operated on.METHODS:The control group was composed of 35 healthy volunteers of 30 to 60 years old,they were measured the level of plasma coagulation and fibrinolysis molecular markers.The Study carried out in 60 patients of 30 to 60 years old who had undergone LC without hyperlipidemia(30cases) and with hyperlipidemia(30cases). Blood samples were taken from dorsalis pedis vein.The following plasma molecular markers were measured:tissue factor activity(TF:A) by subtrate-labeled fluorescent immunoassay(SLFIA);thrombin-antithrombinⅢcomplexes(TAT),tissue-type plasminogen activator(t-PA) and plasminogen activator inhibitor-1(PAI-1) by enzyme-linked immunosorben Assay(ELISA).Samples were obtained at the following time:①on the prepneumoperitoneum during maintenance of anesthesia(call for short: pre-pneumoperitoneum);②at the end of pneumoperitoneum(call for short:post-pneumoperitoneum).The experimental data were analyzed by using a statistical software system SAS11.0,The data intraclass were analyzed by paired samples t test.The Independent Samples t test was used for the intergroup comparison.RESULTS:①Pre-pneumoperitoneum:Differences of TF:A,TAT and t-PA levels were not significant in the control group and LC group;An increase in PAI-1 level was significantly increased in hyperlipidemia group(P＜0.01).②no-hyperlipidemic group (postpneumoperitoneum):It showed significant increase of TAT and t-PA(P＜0.05);In the TF:A and PAI-1 values,no significant differences existed(P＞0.05).③hyperlipidemia group(post-pneumoperitoneum):A significant increase of PAI-1 was found(P＜0.05).Increase of TAT showed a higher degree of significance (P＜0.01).Differences of TF:A and t-PA levels were not significant(P＞0.05).④An increasing degree of TF:A was not significantly different between both groups.An increasing degree of TAT was more significant in the hyperlipidemia group(P＜0.01).An increasing degree of PAI-1 was more significant in the hyperlipidemia group(P＜0.05). An increasing degree of t-PA was more significant in the no-hyperlipidemic group (P＜0.05).CONCLUSIONS:①There is no significant activity of TF during LC,extravascular coagulation pathway(TF pathway) might play a little role in initiation of the coagulation and fibrinolysis.It can be speculated,LC might do a mild damage to tissues, It is microtrauma operation.②The increases of both fibrinolysis activity and coagulation activity in no-hyperlipidemic suggest that there is probably less thrombotic risk for them following LC.③As a result of the increase in the coagulation activity and the decrease in the fibrinolytic activity in hyperlipidemia,It seems to signify much thrombotic risk for them following LC.④This study suggests that thromboembolism prophylaxis should be considered in hyperlipidemia patients following LC.