119例脓毒症凝血、抗凝和纤溶功能的临床研究
A clinical study of sepsis-related coagulation disorder
目的 探讨脓毒症患者凝血、抗凝、纤溶等各项实验室指标与SOFA评分、PCT质量浓度、7d存活率的相关性.方法 入组2017年2月至2018年3月武汉大学人民医院重症监护室119例脓毒症患者和外科择期手术119例非脓毒症患者.检测入院时活化部分凝血活酶时间(APTT)、PT国际标准化比值(PT-INR)、纤维蛋白原(FIB)、抗凝血酶Ⅲ活性(AT-Ⅲ)、D-二聚体(D-Dimer)、纤维蛋白原降解产物(FDP)、可溶性血栓调节蛋白(sTM)、凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2纤溶酶抑制物复合物(PIC)、组织型纤溶酶原激活剂及其抑制剂复合物(t-PAI-C).采用Spearman相关性分析上述各项指标与SOFA评分、PCT质量浓度、7d存活率的相关性.结果 ①脓毒症患者入院时sTM、t-PAI-c、TAT与SOFA评分存在正相关;AT-Ⅲ、血小板计数与SOFA评分存在负相关;而PIC与SOFA评分不存在相关.②脓毒症患者入院时sTM、t-PAI-C与PCT存在正相关.血小板计数与PCT存在负相关,AT-Ⅲ、TAT、PIC与PCT不存在相关.③脓毒症患者入院时sTM、t-PAI-C、TAT与7d存活情况存在负相关;AT-Ⅲ、血小板计数与7d存活情况存在正相关;PIC与7d存活情况不存在相关.结论 可溶性血栓调节蛋白(sTM)、凝血酶-抗凝血酶复合物(TAT)、血浆抗凝血酶Ⅲ(AT-Ⅲ)、组织型纤溶酶原激活剂及其抑制剂复合物(t-PAI-C),分别代表内皮细胞损伤,凝血功能高度激活,抗凝功能相对不足,纤维蛋白降解能力降低,是临床监测脓毒症凝血功能紊乱的良好指标,是包括PLT、INR、APTT在内的脓毒症凝血功能障碍的核心诊断标准的有益补充.
更多Objective To study in the correlation of the laboratory markers of coagulation,fibrinolysis and thrombosis in patients with sepsis and SOFA score,the procalcitonin (PCT) concentration and seven-day survival rate.Methods From February 2017 to March 2018,119 patients with sepsis admitted in ICU and another 119 patients with non-sepsis undergoing selective surgery were enrolled as control in this study.APTT (activated partial thromboplastin time),PT-INR (prothrombin time-international normalized ratio),FIB (fibrinogen),AT-Ⅲ (antithrombin Ⅲ),D-Dimer,FDP (fibrinogen degradation products),sTM (soluble thrombomodulin),TAT (thrombin antithrombin complex),PIC (plasmin-a2 plasminogen inhibitor complex) and t-PAI-C (tissue plasminogen activator and its inhibitor complex),were simultaneously monitored at admission.The correlation between the given laboratory markers mentioned and SOFA score,the PCT concentration and seven-day survival rate were analyzed with the Spearman correlation analysis.Results (① In the patients with sepsis,a positive correlation between SOFA score and sTM,t-PAI-C,TAT respectively was found,and a negative correlation between SOFA score and PLT (platelet count) was observed,and no correlation between SOFA score and PIC was noticed.(②) A positive correlation between PCT and sTM,t-PAI-C respectively was significant,a negative correlation between PCT and PLT was marked,and no correlation between PCT and AT-Ⅲ,TAT,PIC respectively was found.(③) A negative correlation between seven-day survival rate and sTM,t-PAI-C and TAT respectively was obvious,a positive correlation between seven-day survival rate and AT-Ⅲ,PLT respectively was occurred,and no correlation between seven-day survival rate and PIC was determined.Conclusions Soluble thrombomodulin (sTM),thrombin-antithrombin (TAT),antithrombin Ⅲ (AT-Ⅲ) and tissue plasminogen activator inhibitor complex (t-PAI-c) were good clinical monitoring indicators of coagulation disorder in patients with sepsis,which were the representative of the endothelial cell damage with highly activated coagulation,relatively insufficient anti-coagulation function and poor fibrin degradation ability.These were good adjuvants to PLT,INR and APTT for core diagnostic criteria of coagulation disorder in sepsis.
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