急性呼吸窘迫综合征血管内皮损伤及凝血、纤溶系统变化的研究

Changes of circulating endothelial cells,blood coagulation,and fibrinolysis indexes in acute respiratory distress syndrome

目的 :探讨急性呼吸窘迫综合征 (ARDS)血循环内皮细胞和凝血、纤溶指标的变化及意义。方法 :对 14例急性肺损伤 (ALI)患者、7例ARDS患者、10例ICU内对照者及 15例健康对照者利用等密度梯度离心方法分离血循环内皮细胞 (CECs) ,检测血浆凝血酶原时间 (PT)、部分凝血活酶时间 (APTT)、纤维蛋白原 (FG)、纤维蛋白原降解产物 (FDP)及D 二聚体等指标。记录APACHEⅡ及LIS评分评价疾病的严重程度及肺损伤程度。结果 :ALI和ARDS组CECs数量明显高于健康对照组和ICU内对照组 (P <0 .0 5 )。ALI及ARDS组CECs数量与其APACHEⅡ评分明显相关 (r =0 .5 5 ,P <0 .0 5及r =0 .6 2 ,P <0 .0 5 ) ,与LIS明显相关 (r =0 .6 0 ,P <0 .0 5及r=0 .5 3,P <0 .0 5 ) ;并且CECs数量与 PaO2 明显负相关 (r =- 0 .4 9,P <0 .0 5及 r =- 0 .6 4 ,P <0 .0 5 )。ALI和ARDS组FDP和D 二聚体较健康对照组及ICU内对照组明显增加 (P <0 .0 5 ) ,ARDS组FG较健康对照组及ICU内对照组明显增加 (P <0 .0 5 ) ,ALI组FG较健康对照组明显增加 (P <0 .0 5 )。结论 :ARDS患者存在的血管内皮损伤可能在其复杂的发病机制中起重要作用。循环内皮细胞及凝血、纤溶指标可作为评价ARDS患者疾病严重程度及肺损伤程度的监测指标。

Objective: To study endothelial injuries by observing the changes of circulating endothelial cells (CECs) in blood,and coagulation and fibrinolysis indexes in acute respiratory distress syndrome (ARDS). Methods: The CECs were separated by using isopyknic centrifugation method in 14 patients with acute lung injury (ALI),7 patients with ARDS,10 ICU controls,and 15 healthy controls. Plasma prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FG), fibrin degradation products (FDP), and D-dimer were determined simultaneously. The APACHEⅡand lung injury score (LIS) were recorded to evaluate the severity of the illness and injury of the lung. Results: Numbers of CECs in ALI group (10.4±2.3) and ARDS group (16.1±2.7) were higher than that in healthy controls (1.9±0.5) and ICU controls (2.6±0.6) ( P <0.05). Both in ALI and ARDS,the CECs number was correlated with APACHEⅡ( r =0.55,P <0.05 and r =0.62,P <0.05 respectively)and LIS( r =0.60,P <0.05 and r =0.53,P <0.05 respectively). The number of CECs was negatively correlated with P aO_2 in ALI and in ARDS( r =-0.49,P <0.05 and r =-0.64,P <0.05 respectively). The FDP and D-dimer were higher in ALI patients and ARDS patients than those in ICU controls and in healthy controls( P <0.05). The FG in ARDS group was significantly higher than that in ICU controls and in healthy controls( P <0.05). In ALI group,the FG was significantly higher than that in healthy controls ( P <0.05). Conclusion: Endothelial damage occurs in ARDS patients,which may play an important role in the pathophysiology of ARDS. Changes of markers of endothelial cell activation and damage,such as CECs,plasma coagulation and fibrinolysis indexes,to some extent,reflect the severity of the illness and that of the injury of the lung in ARDS.