全身炎症反应综合征患儿凝血功能改变及其临床意义的探讨

Coagulation function changes and the clinical implication in children with systemic inflammatory response syndrome

目的研究全身炎症反应综合征（SIRS）患儿出凝血系统的功能改变和临床意义及其对预后的影响。方法采用前瞻性病例对照设计，按照小儿新生儿SIRS新定义将收住ICU的患儿分为SIRS组（24例）、非SIRS组（21例），另设正常对照组（28例）。SIRS组按预后再分为死亡组（10例）和生存组（14例），监测血小板计数（PLT）、凝血酶原时间（PT）、部分凝血酶原时间（APTT）、纤维蛋白原（FBG）、凝血酶-抗凝血酶复合物（TAT）、抗凝血酶Ⅲ（AT-Ⅲ）、蛋白C（PC）、血栓调节蛋白（TM）、D-二聚体（DD）、组织型纤溶酶原激活物（TPA）共10项反映凝血系统功能的指标。结果（1）SIRS组中PT、APTT、TAT、TM、DD、TPA水平均较非SIRS组及对照组升高（P〈0．05）；AT-Ⅲ、PC水平均较非SIRS组及对照组降低（P〈0．05），非SIRS组PC水平较对照组降低（P〈0．05）；PLT、FBG水平在SIRS组、非SIRS组及对照组之间比较差异无显著性（P〉0．05）；（2）SIRS患儿中，死亡组与生存组各出凝血指标间比较差异无显著性（P〉0．05）。结论（1）SIRS患儿存在凝血功能异常，主要表现为凝血活化、抗凝活性的降低和纤溶系统的活化；（2）出凝血分子标志物是疾病早期针对性反映患儿凝血系统所处状态的良好指标；（3）分子标志物对预后的意义尚需大样本进行评估。

Objective To study the coagulation disorder in children with systemic inflammatory response syndrome （SIRS） and their influences on the prognosis. Methods A prospective case-control study was carried out in our ICU. According to the pediatric/neonatal new definition of SIRS, all the patients were divided into 2 groups：SIRS group （24 cases） and non-SIRS group （21 cases）, as well as 28 control cases were included. The SIRS group was divided inta 2 subgroups： death and survivor subgroup. Levels of platelet （PLT）, prothrombin test （PT）, activated partial thromboplastin time （APTT）, fibrinogen （FBG）, thrombin antithrombin complex （TAT）, antithrombin Ⅲ （ AT- Ⅲ ）, protein C （PC）, thrombomodulin （TM）, tissue-type plsminogen activator （TPA）, D-dimer （DD） were measured in all cases. Results （1） Levels of PT, APTT, TAT, TM, DD, TPA were significantly higher in SIRS group than those in non-SIRS group and control group （ P 〈 0.05）. Activities of AT- Ⅲ and PC were significantly lower in SIRS group than those in non-SIRS group and control group （P〈 0.05）. Activity of PC was significantly lower in non-SIRS group than that in control group（P 〈 0.05）. Levels of PLT and FBG were not significantly different among the SIRS group, none-SIRS group and control group（P 〉0.05）. （2） The coagulation indexes of death cases were not significantly different from those of survivors（P 〉0.05）. Conclusion （1） Patients with SIRS have coagulation disorder, characterized by coagulation activation, anticoagulation consumption and fibrinolysis activation. （2） Molecular markers of blood coagulation are good markers to reflect the different stages of early SIRS. （3） Impact of blood coagulation markers on the patients＇ prognosis needs to be further evaluated by enlarging the sample size.