摘要
目的应用脂多糖（LPS，内毒素）刺激全血细胞组织因子（TF）的表达及促凝活性（TF-PCA）增强程度，观察弥散性血管内凝血（DIC）时TF—PCA的改变及在诊断DIC中的意义。方法病例资料来源：华中科技大学同济医学院附属协和医院2005年1月至2007年1月住院急性粒细胞白血病患者，正常埘照组（A组）38例，疾病组中相关凝血检查正常病例（B组）8例，1～2项凝血检查异常组（C组）21例，疑似DIC组（D组，凝血检查3项或以上，但未达到DIC诊断标准者）12例，符合DIC诊断病例（E组）23例。采用用LPS刺激的全血复钙时间检测全血细胞TF活性（Tissue Facwor Clotting Time，TiFaCT），即在抗凝全血中加入或不加LPS于37℃温育一定时间，然后复钙检查全血凝固时间，根据全血凝固时间缩短的程度（△s）来判断TF-PCA的强弱。应用SPSS13．0软件进行成ISD—t检验及双变量相关性处理，以P〈0．05为差异具有统计学意义。结果对受检病例进行回顾性、描述性分析显示DIC、疑似DIC患者TF-PCA分别是（95．2±68．6）、（85．8±16．9）△s与正常组（30．4±25．1）△s比较差异具有统计学意义（P〈0．01），TFmRNA检测、TF—PCA抑制实验结果提示TiFaCT测定TF-PCA有较高的敏感性和特异性。结论DIC和疑似DIC患者在LPS刺激后TF—PCA明显增强，TiFaCT对于DIC的诊断及预后评价有重要临床参考价值。
Objective To evaluate the significance of TF-PCA to the diagnosis of DIC by observing changes of tissue factor（TF） and procoagulant activity （PCA） in patients with disseminated inravascular coagulation（DIC） according to the enhancement degree of whole blood leukocyte-derived TF expression and TF-PCA stimulated by Lipopolysaccharide （LPS）. Method Patients with acute leukemia （AL） were included during hospitalization from Jan. 2005 to Jan. 2007 in Union Hospital of Huazhong University of Science and Technology. Recalcification time of LPS-stimulated whole blood was applied to evaluate tissue factor clotting time （TiFaCT） ： anticoagulated whole blood was incubated at 37℃ for a certain time with or without LPS-stimulation, and then the recalcification time was measured. TF-PCA were evaluated based on the decreased degree of whole blood recalcification time（Δs）. LSD- t test and bivariate correlation analysis were analyzed by using the SPSS software package （version 13.0 for Windows）. A P-value less than 0. 05 was considered statistically significant. Results A retrospective and contrast analysis indicated that Δs in patients with DIC and patients suspected with DIC were （95.2 ±68.6） and （85.8±16.9）, respectively. When compared with normal controls（30.4 ± 25.1 ）, the difference both had extremely statistical significance （ P 〈 0.01 ）. The results of TF mRNA detection and TF-PCA inhibitory experiments showed that the method of TiFaCT had a high sensitivity and specificity for determination of TF-PCA. Conclusions The levels of TF-PCA were obviously elevated after stimulated by LPS in patients with DIC or suspected with DIC. TiFaCT has an important clinical reference value for the diagnostic and prognostic evaluation of DIC.
出处
《中华急诊医学杂志》
CAS
CSCD
2008年第11期1182-1186,共5页
Chinese Journal of Emergency Medicine
基金
国家自然科学基金资助项目（30570774）
关键词
全血细胞组织因子表达
组织因子促凝活性
弥散性血管内凝血
患者
Tissue factor expression of whole blood
Tissue factor procoagulant activity
Disseminated inravascular coagulation
