创伤患者血液组织因子抗凝血酶Ⅲ血液蛋白C活化率水平变化及其与前弥散性血管内凝血的关系研究

Changes of tissue factor, antithrombin Ⅲ, protein C activation levels in injured patients and their relationship with pre - DIC

目的 探讨创伤患者早期血液蛋白C（PC）活化率、组织因子（TF）、抗凝血酶Ⅲ（ATⅢ）的变化及其与前弥散性血管内凝血（前DIC）的相关性。方法将44例患者分为重伤组（ISS≥16分，29例）和轻伤组（ISS〈16分，15例），另10例健康人为正常对照组。44例患者又分为前DIC组（16例）和非前DIC组（28例）。所有研究对象于伤后1、3、6d空腹采外周静脉血．对照组采集空腹外周血3次，检测血液TF、PC活化率及ATIH水平变化。结果重伤组和轻伤组PC活化率、TF水平在伤后明显升高，显著高于对照组（P〈0．01），且重伤组又高于轻伤组（P〈0．05或P〈0．01）；ATIH水平在伤后明显降低，显著低于对照组（P〈0．01），且重伤组又低于轻伤组（P〈0．05）。前DIC组TF、PC活化率水平高于非前DIC组（P〈0．01），而ATHI水平在伤后明显低于非前DIC组（P〈0．01）。相关分析表明，严重创伤患者血液TF、ATⅢ、PC活化率水平的变化与前DIC发生密切相关。结论创伤后急性期TF、ATⅢ、PC活化率水平变化不仅与创伤严重程度有关，且与前DIC的发生显著相关，检测严重创伤患者急性期外周血TF、ATⅢ、PC活化率的水平变化对早期预测DIC具有较重要价值。

Objective To explore the relationship between traumatic pre -disseminated intravaseular coagulation（ DIC ） and the level of tissue factor （TF） , antithrombin Ⅲ （ATⅢ） , protein C activation levels in traumatic patients. Methods Forty - four patients were divided into severe injury group （ ISS ≥ 16, 29 cases）and mild injury group （ISS 〈 16, 15 cases ）, and other 10 healthy people served as the control group. The forty - four patients were also divided into pre - DIC group （ 16 cases ） and non - pre - DIC group （28 cases）. Venous blood was collected in the control group and other groups on 1, 3 and 6 day after the trauma. The changes of TF, ATⅢ, protein C activation levels were determined. Results The TF and protein C activation levels in the mild injury group and severe injury group were higher than those in the control group（P 〈0.01） , and were higher in the severe injury group than in the mild injury group（P〈0.05 or P 〈0. 01）; The ATⅢ levels were lower in the mild injury group and severe injury group than in control group（ P 〈0. 01） , and was lower in the severe injury group than in the mild injury group（ 〈 0. 05）. The TF and protein C activation levels were higher in the pre- DIC group than in non- pro- DIC group （P 〈0.01 ）, the ATⅢ level was lower in pre- DIC group（ P 〈0.01）. Correlation analysis indicated the levels change of TF, ATⅢ and protein C activation level in the severe injury patients were closely relevant to the occurrence of pre - DIC. Conclusion The changes of TF, ATⅢ, protein C activation level were not only relevant to the severity of trauma, but also closely relevant to the occurrence of pre -DIC after trauma. To examine the changes of TF, ATⅢ, protein C activation level at the early stage after trauma is an important for predicting the occurrence of DIC.