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

摘要： 背景　大量研究表明慢性高原病（CMS）患者凝血功能异常，其机制目前了解有限，本研究旨在通过寻找新的指标对CMS凝血功能异常给予评估和判断。目的　探究CMS患者血浆组织因子微粒（TF-MPs）、P-选择素与凝血功能异常的关系。方法　选取2016年12月—2018年9月入住青海大学附属医院的CMS并深静脉血栓患者20例为CMS并血栓组（CMS+T组）、CMS患者40例为CMS组。另选取同期于本院进行健康体检的高原体检健康者28例为高原健康对照组（GY组），于运城市中心医院的平原体检健康者40例为平原健康对照组（PY组）。研究对象均为汉族男性。常规检测研究对象血红蛋白（Hb）、血小板计数（PLT）、凝血酶原时间（PT）、部分凝血酶原时间（APTT）、D-二聚体、TF-MPs、P-选择素。比较PY组、GY组，CMS+T组、CMS组、GY组Hb、PLT、凝血功能（PT、APTT、D-二聚体）、TF-MPs、P-选择素，分析CMS患者TF-MPs、P-选择素、PLT、D-二聚体间的相关性及患者发生深静脉血栓的影响因素，并探究D-二聚体、TF-MPs、P-选择素预测CMS患者发生深静脉血栓的价值。结果　GY组Hb、P-选择素高于PY组（P<0.05）；CMS+T组、CMS组Hb高于GY组，PLT低于GY组，PT、APTT长于GY组（P<0.05）；CMS+T组D-二聚体水平高于CMS组、GY组（P<0.05）；CMS组、CMS+T组TF-MPs、P-选择素高于GY组（P<0.05）；CMS+T组TF-MPs、P-选择素高于CMS组（P<0.05）。CMS患者TF-MPs与P-选择素呈正相关（r=0.589，P<0.001），与PLT呈负相关（r=-0.451，P=0.008）；P-选择素与PLT呈负相关（r=-0.442，P<0.001）。多因素Logistic回归分析结果显示，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〕、P-选择素〔OR=8.236，95%CI（1.381，49.104），P=0.021〕是CMS患者发生深静脉血栓的影响因素。D-二聚体、TF-MPs、P-选择素预测CMS患者发生深静脉血栓的受试者工作特征（ROC）曲线下面积分别为0.939、0.727、0.732，灵敏度分别为85.0%、45.0%、70.0%，特异度分别为92.5%、87.5%、75.0%。结论　长期居住在高原可引起Hb升高和PLT降低，且CMS患者TF-MPs、P-选择素与PLT降低、深静脉血栓形成有一定关系，同时PT、TF-MPs、P-选择素是CMS患者发生深静脉血栓的影响因素，D-二聚体、TF-MPs、P-选择素预测CMS患者发生深静脉血栓有一定价值。

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