重症感染并发多系统脏器功能衰竭时凝血和纤溶系统变化的研究

ANINVESTIGATIONONTHECHANGESOFCOAGULATIONANDFIBRINOLYTICSYSTEMININTENSIVEINFECTIONWITHMULTIPLEORGANSFAILURE

为观察感染性多系统脏器功能衰竭（ＭＳＯＦ）时凝血纤溶系统变化的特点及意义，对６８例不同程度的感染病人做了凝血酶原时间（ＰＴ），活化的部分凝血活酶时间（ＡＰＴＴ）、纤维蛋白原（Ｆｇ）、纤维结合蛋白（Ｆｎ）和Ｄ－二聚体（Ｄ－Ｄｉｍｅｒ）含量、凝血因子Ⅱ、Ⅶ、Ⅹ、ⅩⅡ（ＦⅡ、ＦⅦ、ＦⅩ、ＦⅩⅡ）活性，抗凝血酶－Ⅲ（ＡＴ－Ⅲ）、纤溶酶原（ＰＬＧ）。α２－抗纤溶酶（α２－ＡＰ）、组织纤溶酶原活化物（ｔ－ＰＡ）和纤溶酶原活化物抑制物（ＰＡＩ）活性、血小板（Ｐｌｔ）数量的测定观察。结果表明：重症感染合并ＭＳＯＦ时，ＰＴ、ＡＰＴＴ异常率明显增高，ＦⅡ、ＦⅦ、ＦⅩ、ＦⅩⅡ活性明显减低，Ｐｌｔ明显减少，Ｆｎ含量显著降低，ＡＴ－Ⅲ、ＰＬＧ活性均明显减低，Ｆｇ、Ｄ－Ｄｉｍｅｒ明显增高，ＰＡＩ活性显著升高，ｔ－ＰＡ和α２－ＡＰ活性轻度减低，未合并ＤＩＣ时ＭＳＯＦ的发生率为３８．５％，合并ＤＩＣ时ＭＳＯＦ的发生率为７９．７％（Ｐ＜０．０１）。提示重症感染合并ＭＳＯＦ时凝血、抗凝和纤溶系统机能紊乱，ＤＩＣ为其主要表现之一，其在ＭＳＯＦ的发生发展过程中具有重要作用。

Aninvestigationwasmadeforthesignificanceofchangesofcoagulationandfibrinolyticsysteminintensiveinfectionwithmultiplesystemorganfailure(MSOF).In68caseswithvariousde-greesofinfection,hematologicalexaminations,includingestimationofPT,APTT,Fg,FnandD-Dimer,activationofcoagulationfactorⅡ、Ⅶ、Ⅹ、ⅩⅡ(FⅡ、FⅦ、FⅩ、FⅩⅡ),AT-Ⅲ,PLG,α2-AP,t-PAandcountofplateletswerecarriedout.Theresultswereasfolowes:InintensiveinfectionwithMSOF,PTandAPTTincreasedsignificantly;activityofFⅡ、FⅦ、FⅩandFⅩⅡdecreasedsignificant-lyplateletcountandFndecreasedmarkedly;concentrationofFgandD-Dimerincreasedsignificantly;activityofPAIincreasedmarkedly;activityoft-PAandα2-APdecreasedslightly.TheincidenceofMSOFnotcombinedwithDICwas38.5%,butthatcombinedwithDICwas79.7%(P<0.01).ItissuggestedthatDICisthemostimportantfactorinthedisorderofcoagulationandfibrinolyticsystem.ItplayanimportantroleinthepathogenesisanddevelopmentofMSOF.