摘要
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脓毒症患者人院时sTM、t-PAl—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、1NR、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。
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, 1NR and APTT for core diagnostic criteria of coagulation disorder in sepsis.
作者
魏捷
张东梅
吕菁君
刘艳红
姜洁
李嘉嫦
叶璐
李涛
万曦
Wei Jie;Zhang Dongmei;Lv Jingjun;Liu Yanhong;Jiang Jie;Li Jiachang;Ye Lu;Li Tao;Wan Xi(Department of Emergency Medicine,Renmin Hospital of Wuhan Universit;Department of Laboratory Medical Center,Renmin Hospital of Wuhan University Wuhan,430060 Chin)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2018年第8期905-911,共7页
Chinese Journal of Emergency Medicine
基金
国家自然科学基金（81372020）
