老年脓毒症患者内皮及凝血功能的改变

Alteration of endothelial and coagulation functions in senile patients with sepsis

目的观察老年脓毒症患者内皮及凝血功能指标的变化及其对预后的影响。方法选取120例老年脓毒症患者和50例健康者，将脓毒症患者按照预后分成生存组84例与死亡组36例。采用Sysmex CA-7000型血液凝固仪免疫法测定血管性血友病因子（vWF）和胁二聚体水平，发色底物法测定抗凝血酶活性和蛋白C活性，凝固法测定纤维蛋白原（FIB）水平。结果老年脓毒症患者vWF、D-二聚体水平治疗前、治疗后均高于对照组（P〈0．01），抗凝血酶和蛋白C活性低于对照组，差异有统计学意义（P〈0．05或0．01），FIB在3组中差异无统计学意义（P〉0．05）；治疗后死亡组vWE、D-二聚体水平高于生存组（P〈0．01），抗凝血酶和蛋白C活性低于生存组（P〈0．01），FIB差异无统计学意义（P〉0．05）；治疗后抗凝血酶和蛋白C活性降低、vWF增高12例，死亡10例（83．3％）；上述指标恢复正常39例，死亡仅2例（5．1％），两组比较差异有统计学意义（x^2=26．99，P〈0．01）。结论老年脓毒症患者存在内皮损伤和凝血功能异常，内皮及凝血功能指标可预测患者的预后。

Objective To observe the changes of the endothelial action, coagulation function and their effects on the prognosis in the senile patients with sepsis. Methods A total of 120 senile patients with sepsis and 50 volunteers as the controls were involved. The patients were divided into the survival group （n=84） and the death group （n=36）. Using Sysrnex CA-7000 coagulation analyzer, the von Willebrand factor （vWF） and D-dirner were detected by immunoassay; the antithrombin activity （AT：A） and protein C activity （PC： A） were determined by chromogenic substrate method; the fibrinogen （FIB） level was assayed by solidification. Results The concentrations of vWF and D-dimer were higher in senile patients with sepsis before and after treatment than in the controls （all P〈0.01）, while AT：A and PC..A were lower （P〈0.05 or 0.01）. There were no differences in FIB among the three groups. The vWF and D-dimer levels were higher in the death group than in survival group and the controls （all P〈0.01）, while the AT： a and PC： a were lower （all P〈0.01）. There were no differences in FIB among the 2 groups （all P〉0.05）. Twelve patients showed the decreased AT：A and PC：A and the increased vWF after treatment, 10 of the 12 patients were dead （83.3%）. The 39 patients had the normal levels of AT：A, PC：A and vWF after treatment. Only 2 cases of them were dead（5.1%）. The difference between two groups was significant（P〈0.01）. Conclusions The prognosis can be predicted with the injury of the endothelium and the abnormality of coagulation indexes in the senile patients with sepsis.