Perioperative changes in PIVKA-II
Perioperative changes in PIVKA-II
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DOI：
10.3109/00365513.2015.1058521
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发表时间：
2015-01-01
影响因子：
2.1
通讯作者：
Schott, Ulf
中科院分区：
文献类型：
--
作者：
Dauti, Fredrik;Jonsson, Magnus Hjaltalin;Schott, Ulf
背景和目标。维生素K缺乏诱导的蛋白质因子II（PIVKA-II）是一种酶联免疫吸附试验，可监测未羧化凝血酶原，并在凝血酶原试验变化前对维生素K缺乏作出反应。本项目的目的是在一项前瞻性观察性研究中研究各种类型手术期间的围手术期PIVKA-II变化。方法.纳入接受腹部或骨科手术的患者。在手术当天（术前）和手术后5天内采集血样。分析活化部分凝血活酶时间、Quick和Owren凝血酶原时间以及PIVKA-II。结果共纳入39例患者，其中男性27例，女性12例。除7例患者外，所有患者术前PIVKA-II水平均升高。与术前血浆水平相比，术后第1天PIVKA-II水平已显著升高（p <0.017）。中位PIVKA-II在第5天最高。常规检查基本正常。当比较接受腹部手术与骨科手术的患者时，未观察到PIVKA-II的显著差异。PIVKA-II与常规凝血试验无显著相关性。前切除术、急诊剖腹手术和急诊髋部骨折患者术后增加更高，这可能与胃肠道恢复时间增加、麻痹性肠梗阻、腹膜炎和合并症有关。结论. PIVKA-II水平在围手术期增加，尽管大多数常规凝血试验正常。应研究PIVKA-II水平升高患者的术前和围手术期维生素K补充，并在未来的研究中确定其临床意义。
Background and aims. Proteins induced by vitamin K absence for factor II (PIVKA-II) is an enzyme-linked immunosorbent assay that monitors uncarboxylated prothrombin and responds to vitamin K deficits prior to changes in the prothrombin test. The aim of this project was to study perioperative PIVKA-II changes during various types of surgery in a prospective observational study. Methods. Patients undergoing abdominal or orthopaedic surgery were included. Blood was sampled on the day of surgery (preoperatively) and up to 5 days after surgery. The activated partial thromboplastin time, Quick and Owren prothrombin times were analyzed, together with PIVKA-II. Results. Thirty-nine patients were included, 27 male and 12 female. All but 7 patients had elevated PIVKA-II levels preoperatively. PIVKA-II levels had already increased significantly (p < 0.017) on day 1 after surgery as compared to presurgery plasma levels. The median PIVKA-II was highest on day 5. Routine tests were mostly normal. No significant difference in PIVKA-II was seen when comparing patients undergoing abdominal versus orthopaedic surgeries. There was no significant correlation between PIVKA-II and routine coagulation tests. Patients with anterior resection, emergency laparotomy and emergency hip fractures had higher postoperative increases, which could be linked to increased gastrointestinal recovery times, paralytic ileus, peritonitis and comorbidities. Conclusions. PIVKA-II levels increase during the perioperative period, despite mostly normal routine coagulation tests. Pre- and perioperative vitamin K supplementation in patients with elevated PIVKA-II levels should be studied, and its clinical significance be defined in future studies.