连续性血液净化对多器官功能障碍综合征患者凝血功能的影响

Changes of tissue factor pathway in patitents with multi organ dysfunction during continuous blood purification

目的:观察连续性血液净化治疗多器官功能障碍综合征(MODS)患者过程中血浆组织因子(TF)、组织因子途径抑制物(TFPI)的变化,并分析影响其变化的相关因素。方法:16例MODS患者随机分为两组,一组给予无肝素连续性静脉-静脉血液透析滤过(CVVHDF)治疗,另一组给予普通肝素抗凝的CVVHDF治疗。观察患者行CVVHDF治疗8h过程中的变化,在治疗0、15min、1h、2h、8h时检测血浆TF及TFPI水平,同时测定血清肿瘤坏死因子(TNF-α)、IL-1β水平,并分析影响TF、TFPI水平变化的相关因素。结果:MODS患者TF、TFPI水平较正常对照组明显升高(P<0.01),TFPI/TF水平较正常对照组显著降低(P<0.01)。CBP治疗过程中,两组患者血浆TF呈下降趋势,而TFPI呈上升趋势。TFPI/TF水平随着CBP时间的延长呈上升趋势。肝素组TFPI/TF上升幅度更为明显,与无肝素组比较差异有统计学意义(P<0.05)。无肝素组CBP治疗MODS患者不同时间点血清TNF-α、IL-1β与血浆TF均呈正相关(P<0.05)而在肝素组无明显相关(P>0.05)。结论:MODS患者分泌TF、TFPI增加,TFPI/TF降低,CBP可部分改善TFPI/TF比例,与CBP清除TNF-α与IL-1β相平行。肝素可增加TFPI的分泌。

Objective：To observe the changes of tissue factor（TF） pathway during continuous blood purification and correlation factors. Methodology：Sixteen patients who diagnosed MODS were divide into two groups randomly in this study. Eight patients were underwent CBP with heparin anticoagulation, 8 patients were underwent CBP without anticoagulation. All of patients underwent CBP for 8 hours. The blood was taken from those patients at 0, 15, 60,120 and 480 min during CBP. Plasma tissue factor, tissue factor pathway inhibitor （TFPI） and serum TNF-α, IL-1β were measured by ELISA. Results ： The plasma levels of TF and TFPI of MODS were increased while TFPI/TF was decreased significandy compared with control group （ P 〈 0. 0l ）. The plasma levels of TF were decrease and TFPI was increased after CBP. TFPI/ TF was increased in the group of heparin compared with the group of free-heparin（P 〈 0. 05 ） after CBP. There were significant positive correlations between plasma TF and corresponding serum TNF-α or IL-1β in the group of free-heparin （ P 〈 0. 05 ）, but there were not significant correlations in the group of heparin. Conclusion：There was the dysfunction of endothelium and the increase of TF and TFPI in patients with MODS. Those abnormalities were ameliorated after CBP treatment.