多发伤患者APC活化率、ATⅢ水平变化及临床意义

Clincal significance of the shift of APC % and antithrombin Ⅲ in multiple trauma patients

目的探讨多发伤患者早期蛋白c活化率（APC％）、抗凝血酶Ⅲ（ATⅢ）的变化及临床意义。方法44例多发伤于1、3、6d空腹采外周静脉血一次，另10例健康人为正常对照组，于体检时第1、3、6d空腹采外周静脉血一次，检测血液APC活化率及ATⅢ浓度变化。结果伤后APC％显著高于对照组（P〈0．05），前DIC组高于非前DIC组（P〈0．01）；ATⅢ在伤后明显降低，显著低于对照组（P〈0．05），前DIC组明显低于非前DIC组（P〈0．01）；APC％／ATⅢ在伤后持续升高，其比值与伤后前DIC发生与否成正相关性（r=0．75，r=0．79，P〈0．01）。结论创伤后急性期ATⅢ、APC％水平变化与创伤严重程度有关，对这两项指标进行检测有助于预测患者病情进展及预防并发症的发生。

Objective To evaluate the clinical significance of the shift of activated rate of activated protein C （APC%） and antithrnmbin III （ATIII） in patients with multiple trauma. Methods Peripheral blood samples were collected from 44 multiple trauma patients, 34 males and 10 females, aged （36.4---9.0） （22-61）, 16 showing pre-disseminated intravascular coagulation （pre-DIC）, and 28 without manifestaions of pre-DIC, 1, 3, and 6 days after trauma to undergo examination of APC% and ATIII. Ten healthy persons undergoing health physical examination were used as controls. Results The plasma ATIII levels of the multiple trauma patients progressively decreased （P〈0.01）, and those 1, 3, and 6 days after trauma were all significantly lower than those of the nomal control group at any time points （all P〈0.01）. The activated rate of APC of the patients progressively increased after trauma （P〈0.01）, and those 1, 3, and 6 clays after trauma were all significantly higher than those of the nomal control group at any time points （all P〈0.01）. The activated rates 1, 3, and 6 days after trauma of the pre-DIC group were all significantly higher than those of the non-pre-DIC group （all P〈0101）. The plasma ATIII levels 1, 3, and 6 days ater trauma of the pre-DIC group were all significantly lower than those of the non-pre-DIC group （all P〈 0.01）. The APC/ATIII values of the patients progressively increased ater trauma, however, the APC/ATIII values of the non-pre-DIC group were all significantly lower than those of the pre-DIC group （all P〈0.01）, The APC/ATII1 value and APACHE II were significantly correlated with the APACHE II score and the incidence of pre-DlC （i=-0.75, r=-0.79, P〈0.01）. Conclusion The ATIII and APC% levels in the early stage after trauma is related to the severity of trauma, and are valuable to predict the progress of the condition, such as the occurrence of DI.