急性肺损伤患者早期PAI-1、t-PA、AT-Ⅲ测定及其临床意义

The coagulation and fibrinolysis status in the early stage of acute lung injury

目的探讨急性肺损伤(ALI)患者早期凝血、纤溶的变化规律及其对ALI患者预后的影响。方法ALI组患者22例,按有无多脏器功能不全综合征(MODS)和是否死亡分为MODS组和非MODS组、死亡组和存活组;ICU内对照组10例,健康对照组10例。均除外血液病、肝病和肿瘤。ALI组、ICU内对照组、健康对照组的性别、年龄构成比较差异无统计学意义(P>0.05)。ALI组在确诊3d内,ICU对照组在入ICU3d内,健康对照组在体检当天,测定纤溶酶原激活剂抑制物-1(PAI-1)、组织型纤溶酶原激活剂(t-PA)、抗凝血酶Ⅲ(AT-Ⅲ)的含量。结果⑴ALI组与健康对照组相比,PAI-1、t-PA值显著升高、AT-Ⅲ值显著降低(P<0.01);⑵MODS组PAI-1值、t-PA值高于非MODS组(P<0.05),AT-Ⅲ值低于非MODS组(P<0.05);⑶死亡组AT-Ⅲ值低于存活组(P<0.05)。结论⑴ALI早期表现为高凝、纤溶活性降低;⑵病情严重者凝血、纤溶系统变化更显著;⑶AT-Ⅲ降低可能是预后不良的指标。

Objective To investigate the coagulation and fibrinolysis status and related parameters in patients with acute lung injury （ALI） at the early stage. Methods Twenty two cases with ALl were divided into two groups： MODS （multi-organ deficiency syndrome） group and death group; meanwhile 10 ICU controls and 10 healthy controls were also included, The parameters including PAI-1,t-PA and AT-Ⅲ were measured in all patients and controls. Results In ALI group the levels of PAI-1 and t-PA were significantly higher and AT -Ⅲ lower than those in healthy controls（P〈0.01 ）. The PAI-1 and t-PA levels in MODS group were significantly higher, while AT- Ⅲ level was lower than those in non-MODS group （P〈0. 05 ）. Compared with the survivors, the AT- Ⅲ level of fatal cases was significantly lower （ P〈0.05 ）. Conclusion There are high coagulation and low fibrinolysis at early stage of ALl. Changes of coagulative and fibrinolytic parameters may reflect the severity of ALI. Low AT- Ⅲ level might be a predictive marker for mortality of ALI at the early stage.