四肢严重创伤患者PAI-1、TF、ATⅢ水平变化及与并发症的相关性研究

Changes in serum PAI-1,TF and ATⅢ in severe limb injury and their relationship with complications

目的探讨四肢严重创伤患者早期纤溶酶原激活物抑制物1(PAI-1)、组织因子(TF)、抗凝血酶Ⅲ(ATⅢ)的变化及其与伤后前DIC、DIC等并发症的关系。方法将35例患者分为重伤组(AIS评分≥3分,20例)和轻伤组(15例),另选取10例健康人为对照组。35例患者又分为前DIC组10例、DIC组3例,其余22例。35例患者于伤后第1、3、6天空腹采外周静脉血,检测血液PAI-1、TF及ATⅢ浓度变化并与对照组比较。结果重伤组和轻伤组PAI-1在伤后第1天明显高于对照组(P<0.05),TF浓度在伤后第1、3、6天明显高于对照组(P<0.05),且重伤组明显高于轻伤组(P<0.05),ATⅢ在伤后第1、3、6天明显低于对照组(P<0.05),且重伤组明显低于轻伤组(P<0.05)。DIC组TF在伤后各时间点、PAI-1在伤后第1天明显高于前DIC组(P<0.05),而ATⅢ在伤后第1、3天明显低于对照组和前DIC组(P<0.05)。伤后TF水平与DIC、前DIC的发生呈明显正相关,ATⅢ水平与DIC、前DIC的发生呈明显负相关。结论创伤后急性期TF、ATⅢ、PAI-1水平变化与创伤严重程度有关,对这三项指标进行检测有助于预测四肢伤患者病情进展及并发症发生情况。

Objective To explore the changes in serum plasminogen activator inhibitor 1 （PAI-1）, tissue factor （TF） and an tithrombin Ⅲ （ATⅢ） in early period of severe limb injury, and their relationship with the occurrence of traumatic pre-DIC and DIC after trauma. Methods Thirty-five patients were divided into severe injury group （ MS score 93, 20 cases）, minor injury group （15 cases）, and 10 healthy subjects served as control. The 35 patients with injury were divided again into pre-DIC group （10 cases）, DIC group （3 cases）, and others （22 cases）. Fasting peripheral venous blood was collected on day 1, 3, 6 from the patients and healthy subjects. The changes in TF, ATⅢ and PAI-1 levels were detected and statistically analyzed. Results The PAIl levels were higher in minor injury group and severe injury group than that in control group on day 1 （P〈0.05） ; the TF levels were higher in the two injury groups than that in control group on day 1, 3 and 6 （P〈0. 05）, and the TF levels in severe injury group were higher than that in minor injury group （P〈0.05） ; the ATⅢ levels were lower in the two injury groups than that in control group on day 1, 3 and 6 （P〈0. 05）, and the ATⅢ levels in severe injury group were lower than that in minor injury group （P〈0. 05）. For the two injury groups, the TF levels on day 1, 3 and 6, and PAI 1 level on day 1 in DIC group were higher than that in pre-DIC group （P〈0.01）, and the AT Ⅲ levels on day 1 and 3 in DIC group were lower than that in pre-DIC group （P〈0.01）. There was a significant positive correlation between TF levels and the occurrence of traumatic pre-DIC and DIC after trauma, and a significant negative correlation between AT Ⅲ levels and the occurrence of traumatic preDIC and DIC after trauma. Conclusion At the early stage of limb injury, the levels of TF, ATⅢand PAP1 are correlated with the severi ty of trauma. Detection of these three markers is helpful to foretell the course of the injury and prevent the occurrence of complications, es pecially coagulopathy, after severe limbs injury.