弥散性血管内凝血患者出凝血分子标志物的检测及其临床意义

Clinical Significance of Molecular Markers of Blood Coagulation and Hemostasis in Patienst with Disseminated Intravascular Coagulation

目的探索弥散性血管内凝血(DIC)患者血浆出凝血分子标志物的变化并探讨其临床意义。方法将67例DIC患者根据病程分为DIC早期(初发高凝血期)、中期(消耗性低凝期)和晚期(继发性纤溶亢进期),测定其常规血凝学指标,用酶联免疫吸附法检测67例DIC患者血浆血小板α颗粒膜蛋白-140(GMP-140)、抗凝血酶(AT)、D-二聚体(D-D)、凝血酶-抗凝血酶复合物(TAT)、凝血酶原片段F1+2、纤溶酶-抗纤溶酶复合物(PAP)含量,并与38例正常人对照。结果DIC早期F1+2、D-D、TAT含量均显著高于正常对照组(P＜0.01),GMP-140、PAP含量明显高于正常对照组(P＜0.05),AT活性显著降低,与正常对照组比较差异有显著性(P＜0.05)；在DIC中晚期F1+2、D-D、TAT、GMP-140明显升高,AT活性明显降低,与正常对照组比较差异有显著性(P＜0.01),以直线相关分析,D-D与F1+2、GMP-140、TAT在DIC患者中有显著性相关(r=0.871,P＜0.05；r=0.763,P＜0.05)。结论出凝血分子标志物能早期反映体内凝血、抗凝及纤溶系统激活的敏感性指标,在DIC早期诊断中有实用价值。

Objective To investigate the changes of plasma levels of the molecular markers of blood coagulation and hemostasis in patients with disseminated intravascular coagulation（DIC） and to discuss their clinical significances. Methods 67 cases diagnosed clinically as DIC were divided into three groups according to the course of DIC：early,mid and late stages . Routine coagulation tests （PT,aPTT,TT,3P and BPC） and a series of blood coagulation and hemostatic molecular markers ,comprise GMP-140, AT, （TAT）, D-Dimer, F 1 ＋ 2, PAP were mersured by enzyme-linked immunosorbent assay （ELISA） methods in 67 DIC patients and 38 normal controls. Results The plasma levels of F 1 ＋ 2, D-Dimer and TAT were markedly higher in early stage of DIC than that of normal controls （P 〈0.01 ） ,the levels of GMP-140 and PAP were markdely higher in early stage of DIC than that of normal controls （ P 〈 0.05 ）, and the activities of AT was markedly lower than those in control group （ P 〈 0.05 ）. The plasma levels of F 1 ＋ 2, D-Dimer, TAT and GMP-140 were markdely higher in mid and late stage of DIC than that of normal controls（P 〈0.01 ） ,and the activities of AT was markedly lower than that of control （ P 〈 0.01 ）. The levels of D -Dimer were positive correlation with F 1 ＋2, GMP-140, TAT（r =0. 871 ,P 〈0.01 ;r =0. 697 ,P 〈0.05 ;r =0.763 ,P 〈0.05 respectively）. Conclusion The molecular markers of blood coagulation and hemostasis are sensitive indexes, shich can early reflect coagulation , anti-coagulation and fibrinolysis,and had important practical value n early diagnosis of DIC.