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目的:探讨不明原因鼻出血患者的发病机制。方法:采用酶联免疫吸附测定法(ELISA法)测定19例不明原因鼻出血患者(鼻出血组)和36例健康体检者(正常对照组)血中尿激酶型纤溶酶原激活物(uPA)及其受体(uPAR)的水平,同时测定凝血4项及用乳胶法作D-二聚体定性测定。结果:鼻出血组治疗前:uPAR(0.14±0.04)μg/L,uPA(0.24±0.09)μg/L;治愈后:uPAR(0.08±0.02)μg/L,uPA(0.18±0.07)μg/L。正常对照组:uPAR(0.07±0.03)μg/L,uPA(0.17±0.05)μg/L。鼻出血组治疗前uPAR、uPA均高于对照组,差异有统计学意义(P<0.05),鼻出血组治疗后与正常对照组比较差异无统计学意义(P>0.05);凝血4项与正常对照组比较均差异无统计学意义(均P>0.05)。结论:不明原因鼻出血患者的uPAR、uPA表达增高原因未明,可能与局部区域由于炎症而使微循环的血管内皮细胞、平滑肌细胞以及血液粒-单核系细胞释放过多的uPAR、uPA有关,高浓度的uPAR、uPA微环境,使鼻腔内血液微环境纤溶活性增高引发纤溶亢进,因而引起局部血液处于低凝状态而引发鼻出血。
Objective: To explore the pathogenesis of unexplained nosebleeds. Methods: Serum levels of urokinase-type plasminogen activator (uPA) in 19 patients with unreasonable nosebleed (nasal hemorrhage) and 36 healthy controls (normal control group) were determined by enzyme linked immunosorbent assay (ELISA) ) And its receptor (uPAR) levels, simultaneous determination of coagulation 4 and latex qualitative determination of D-dimer. Results: The levels of uPAR (0.14 ± 0.04) μg / L and uPA (0.24 ± 0.09) μg / L before the treatment in the epistaxis group were significantly lower . The normal control group: uPAR (0.07 ± 0.03) μg / L, uPA (0.17 ± 0.05) μg / L. The levels of uPAR and uPA in epistaxis group before treatment were significantly higher than those in control group (P <0.05), but there was no significant difference between nasal hemorrhage group and normal control group (P> 0.05) There was no significant difference between the normal control group (all P> 0.05). CONCLUSIONS: The reasons for the increased expression of uPAR and uPA in patients with unexplained epistaxis may be related to the excessive release of uPAR and uPA in microcirculatory vascular endothelial cells, smooth muscle cells and blood granulocyte-mononuclear cells in the local area due to inflammation, High concentrations of uPAR, uPA microenvironment, nasal fibrinolysis increased blood fibrinolytic activity caused by increased fibrinolytic activity, which led to the local blood in a low coagulation state and lead to epistaxis.