严重多发伤患者血浆凝血酶原片段1+2 D-二聚体血栓调节蛋白水平的变化及与DIC的关系

Changes of plasma prothrombin fragment 1+2,D-dimer,thrombomodulin levels in multiple injury patients and their relationship with DIC

目的探讨严重多发伤患者血浆凝血酶原片段1+2(F1+2)、D-二聚体(D-D)、血栓调节蛋白(TM)水平的变化及与创伤后DIC之间的关系。方法将66例多发伤患者分为轻伤组(ISS<16分,21例)和重伤组(ISS≥16分,45例),再把重伤患者分为并发DIC组(12例)和未并发DIC组(33例),另10例健康人为正常对照组。正常对照组采外周静脉血1次,其余组分别于伤后1、3、7 d空腹采集外周静脉血,应用ELISA方法测定血浆F1+2和TM水平,全自动乳胶微粒增强免疫比浊分析方法测定血浆D-D水平。结果轻伤组和重伤组血浆F1+2、D-D、TM水平伤后均明显高于正常对照组,且重伤组又明显高于轻伤组。非DIC组伤后F1+2、D-D水平逐渐降低,而TM水平迅速降低;DIC组F1+2、D-D水平持续升高,TM水平先升高后降低,DIC组F1+2、D-D、TM水平显著高于非DIC组。血浆F1+2、D-D和TM水平相互之间在各个时相点呈明显的正相关。结论创伤后急性期F1+2、D-D和TM水平的升高程度不仅与创伤严重程度有关,而且与创伤后DIC的发生密切相关。因此,测定严重多发伤患者急性期外周血浆F1+2、D-D和TM水平变化对预测创伤后DIC的发生具有一定价值。

Objective To explore the relationship of traumatic disseminated intravascular coagulation （ DIC ） with the levels of plasma prothrombin fragment 1 ＋ 2 （ F1 ＋ 2 ） , D - dimer （ D - D ） and thrombomodulin （TM） in severe multipleinjury patients. Methods 66 multiple injury patients were divided into mild injury group（ ISS 〈 16,21cases） and severe multiple injury group （ISS ≥ 16, 45cases） , which were sub divided into DIC group （ 12cases ） and non - DIC group （ 33 cases ）. Another 10 healthy people served as the control group. Venous blood was collected for once in the control group and in other groups venous blood was collected on 1,3 and 7 day after trauma. The F1 ＋ 2 and TM concentrations were determined with ELISA, and the D - D concentrations were measured by automated latex enhanced immunoassay. Results The F1 ＋ 2, D -D and TM levels in the mild injury group and severe multiple injury group were both higher than those in the control group, and the severe injury group were remarkably higher than the mild injury group. In the non - DIC group, F1 ＋ 2 and D - D levels gradually declined, while TM levels continuously declined; In the traumatic DIC group, F1 ＋ 2 and D -D levels increased continuously, while TM levels rose first and then decreased remarkably, the plasma F1 ＋ 2, D - D and TM levels of the DIC group Were remarkably higher than those of the non - DIC group. Plasma F1 ＋ 2, D - D and TM levels had significantly positive correlations at every time phase. Conclusion The F1 ＋2, D -D and TM levels were not only relevant to the severity of trauma, but also closely to the occurrence of traumatic DIC after trauma. The detection of plasma F1 ＋2, D -D and TM levels can predict the occurrence of DIC early.