关键词: 高原病, 凝血功能, P选择素, 静脉血栓形成, 凝血酶, 凝血酶原时间

Abstract: Background　Many studies have shown that patients with chronic mountain sickness（CMS） have abnormal coagulation and the mechanism is still unclear．The purpose of this study was to find out new indicators to evaluate the status of abnormal coagulation．Objective　To explore the relationship of abnormal coagulation with plasma TF-MPs and P-selectin in CMS patients．Methods　Participants were Chinese Han males who were enrolled during December 2016 to September 2018，including 20 inpatients with CMS and deep vein thrombosis（CMS+T group），40 inpatients with CMS（CMS group），and 28 physical examinees from plateau regions（plateau control group） from Qinghai University Affiliated Hospital，as well as 40 physical examinees from plain regions from Yuncheng Central Hospital（plain control group） ．Hemoglobin（Hb），platelet count（PLT），coagulation parameters 〔prothrombin time（PT），partial prothrombin time（APTT），and D-dimer〕，TF-MPs and P-selectin were routinely detected and compared in all groups．Correlations of PLT，and D-dimer with F-MPs and P-selectin were analyzed．The factors associated with deep vein thrombosis in CMS were identified．Predictive value of D-dimer，TF-MPs and P-selectin for deep vein thrombosis in CMS were explored.Results　Compared with plateau control group，plain control group had lower mean levels of Hb and P-selectin，CMS+T and CMS groups had higher mean levels of Hb，lower mean level of PLT，and longer mean PT and APTT（P<0.05）．The mean D-dimer level in CMS+T group was higher than that in CMS group and plateau control group（P<0.05）．The mean TF-MPs and P-selectin levels in CMS and CMS+T groups were higher than those in plateau control group（P<0.05）．And they were also higher in CMS+T group than those in CMS group（P<0.05）．In CMS patients，TF-MPs was positively correlated with P-selectin（r=0.589，P<0.001），and was negatively correlated with PLT（r=-0.451，P=0.008）．P-selectin was negatively correlated with PLT（r=-0.442，P<0.001）．Multivariate Logistic regression analysis PT〔OR=0.138，95%CI（0.026，0.735），P=0.020〕，TF-MPs〔OR=8.067，95%CI（1.660，39.200），P=0.010〕and P-selectin 〔OR=8.236，95%CI（1.381，49.104），P=0.021〕were associated with deep vein thrombosis in CMS patients．The area under ROC curve of D-dimer，TF-MPs and P-selectin for predicting deep vein thrombosis in CMS patients was 0.939，0.727 and 0.732，respectively，the sensitivity was 85.0%，45.0% and 70.0%，and the specificity was 92.5%，87.5% and 75.0%，respectively．Conclusion　Long-term high altitude exposure may lead to elevated Hb and decreased PLT．In CMS patients，TF-MPs and P-selectin are associated with decreased PLT and deep vein thrombosis．PT，TF-MPs and P-selectin are the influencing factors of deep vein thrombosis．And D-dimer，TF-MPs，and P-selectin all have certain value in predicting deep vein thrombosis.

Key words:  , Altitude sickness；Coagulation；P-selectin；Venous thrombosi；Thrombin；Prothrombin time