凝血-纤溶动态图在脓毒症凝血纤溶失衡检测中的应用

Utility of coagulation and fibrinolysis dynamicogram for detection of imbalance between coagulation and fibrinolysis in patient with sepsis

目的探讨凝血-纤溶动态图(CF)在检测脓毒症患者凝血和纤溶失衡中的作用。方法对24例脓毒症患者和20例健康人的凝血、纤溶变化,进行常规方法检测和凝血-纤溶动态图检测。对比分析常规检测和凝血-纤溶动态图的特点。结果在常规检测方法中,与对照组比较脓毒症凝血酶原时间(PT)缩短,纤维蛋白元含量(Fbg)增加,差异有统计学意义(P<0.05),提示血液处于高凝状态。与对照组比较脓毒症D-二聚体(D-D),纤溶酶原含量(Plg)增加,差异有统计学意义(P<0.05),提示血液处于继发纤溶亢进状态。在CF检测中,与对照组比较脓毒症反应时间(CST)、凝固时间(CT)缩短,最大振幅(ME)、聚合速度(ACE)增加,差异有统计学意义(P<0.05),提示血液处于高凝状态。与对照组比较,虽然脓毒症组溶解时间(FT)延长,但溶解速度(AFE)增加,差异有统计学意义(P<0.05),提示血液处于纤溶亢进状态。脓毒症组中平衡时间(BLT)、平衡指数(BLE)2.55±0.39、2.05±0.21与对照组2.25±0.34、1.70±0.19比较增加,差异有统计学意义(P<0.05),显示脓毒症凝血-纤溶的平衡被打破,凝血为主。结论凝血-纤溶动态图既有凝血和纤溶的参数,又有平衡参数,在检测脓毒症患者凝血纤溶的不平衡中,比常规方法更敏感、特异。

Objective To determine the role of coagulation and fibrinolysis dynamicogram （CF） in imbalance between coagulation and fibrinolysis from normality in sepsis. Methods Routine tests and CF were applied to detect the changes of coagulation and fibrinolysis for 24 patients with sepsis and 20 healthy individuals（control）. The characteristic of routine tests and CF was analyzed by contrast during the changes of coagulation and fibrinolysis in the patients with sepsis. Results In routine test, compared with control individuls, there was statistically significant decurtation of prothrombin time （PT） and higher fibrinogen （Fbg） levels in the patients with sepsis,indicating there was hypercoagulation states in the patients with sepsis. Compared with control individuls, there were statistically significant higher D-dimer （D-D） and plasminogen （Pig） levels of routine parameters in the patients with sepsis, indicating there was hyperfinrinolysis state in the patients with sepsis. In CF,compared with control individuals,there was statistically significant deeurtation of coagulation start time （CT） and coagulation start time（CST） and higher max extent（ME） and accelerating coagulation effect（ACE） levels of CF parameters in the patients with sepsis, indicating there was hypercoagulation state in the patients with sepsis. Although there was statistically significant prolonged fibrinolysis time（FT）,statistically significant higher accelerating fibrinolysis effect（AFE） level in the patients with sepsis, indicating there was hyperfinrinolytic state in the patients with sepsis. Meanwhile, there were balance parameters in CF. Compared with control individuals, there were statistically significant higher balance level time（BLT）,balance level exponent（BLE） levels （ BLT,2.55 ± 0.39, BLE 2.05±0.21）in sepsis than control （BLT, 2.25 ± 0.34, BLE 1.70 ± 0. 19）. The findings indicated that there was imbalance state of coagulation and fibrinolysis and hypercoagulation state was a main factor between hypercoagulation and hyperfinrinolysis in the patients with sepsis. Conclusion Because there is both routine parameter and parameter of balance between coagulation and fihrinolysisi in CF,CF is more sensitive and specific than routine tests for differentiating imbalance between coagulation and fibrinolysis from normality in sepsis.