Relationship between protein C, protein S and antithrombin III and prognosis in children undergoing Rex shunt

Abstract

Objective To explore the relationship between protein C, protein S and antithrombin Ⅲ and prognosis in children undergoing Rex shunting. Methods From December 2013 to April 2016, 53 children (32 boys and 21 girls) with portal cavernous underwent Rex shunting. Both pre- and post-operative blood samples were collected. The blood samples of 18 normal children were used as control group. The concentration of protein C (PC), protein S (PS) and antithrombin Ⅲ (ATⅢ) and activity of antithrombin Ⅲ were detected by enzyme-linked immunosorbent assay (ELISA) Kit. Based on post-shunting prognosis, they were grouped into re-bleeding and non-bleeding groups. The values of PC, PS and ATⅢ between re-bleeding and non-bleeding groups and control group were compared. Based on the diameter of bypass vein as measured by postoperative sonography and computed tomography (CT), they were grouped into no less than 5 mm and <5 mm groups. PC, PS and AT Ⅲ were compared between no less than 5 mm and less than 5 mm groups and re-bleeding group. Results The activity of ATⅢ and concentration of PS were significantly lower in re-bleeding group than those in control group (55.6±4.8 vs 61.7±5.1 U/ml, P=0.003; 1.9±0.2 vs 2.4±0.2 μg/ml, P=0.000). No difference existed in the concentration of PC and ATⅢ between re-bleeding and control groups (P=0.109 & 0.085). The activity of ATⅢ was significantly lower in re-bleeding group than that in non-bleeding group (55.6±4.8 vs 59.8±6.4 U/ml, P=0.015). No difference existed in concentrations of PC, PS and ATⅢ between re-bleeding and non-bleeding groups (P=0.253, P=1.000 and P=0.677). The activity of ATⅢ was significantly lower in re-bleeding group than that in no less than 5 mm group (55.6±4.8 vs 60.4±6.2 U/ml, P=0.010). No difference existed in the activity of ATⅢ between re-bleeding and <5 mm groups (55.6±4.8 vs 58.7±6.8 U/ml, P=0.140). Conclusions Reduced activity of ATⅢ is significant in re-bleeding children after Rex shunting. As an important prognostic indicator of Rex shunting, it may be a result of decreased hepatopetal blood flow. Key words: Hypertension, portal; Rex shunt; Prognosis