慢性阻塞性肺疾病急性加重期重症患者凝血纤溶动态变化及其临床意义

Dynamic changes and clinical significance of coagulation and fibrinolytic markers in severe AECOPD

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)重症患者的凝血纤溶变化规律及其临床意义。方法对本院2009年2月至2010年10月收治的50例AECOPD重症的患者进行前瞻性研究,测定其入院第1天、第3天和第7天血管内皮素(ET)、血小板颗粒蛋白-140(GMP-140)、D-二聚体(D-dimer,D-D)及入院第1天、第3天和第7天部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血时间(TT);取同期健康人群40例作对照组。结果 ET、GMP-140、D-D在入院第1天明显升高,第3天仍高于正常,没有明显下降趋势,与对照组比较有显著差异(P<0.05),第7天GMP-140、ET及D-D均有所下降,但仍高于对照组(P<0.05)。APTT、PT、TT在入院第1天明显延长,7d病程内有下降趋势,但至第7天时与对照组比较仍有显著差异(P<0.05)。ET、GMP-140、D-D水平与APHECHEⅡ评分呈正相关(P<0.05),APTT、PT、TT与APHECHEⅡ评分无相关性(P>0.05);ET、GMP-140、D-D水平与动脉血PCO2呈正相关(P<0.05),APTT、PT、TT与动脉血PCO2无相关性(P>0.05)。结论 AECOPD重症均伴有凝血纤溶异常,其异常程度与AECOPD病情严重程度有相关性。

Objective To investigate the dynamic changes and clinical significance of coagulation and fibrinolytic markers in AECOPD.Methods Fifty cases of severe AECOPD were included in the study.The endothelin（ET）,alpha-granular membrane protein-140（GMP-140）,D-dimer levels and active partial thromboplstin time（APTT）,prothrombin time（PT） and thrombin time（TT） were measured.The statistical significance was accepted at P〈0.05.Results ET,GMP-140,D-dimer levels were significantly increased at the time of admission,and then were gradually decreased,but still significantly higher than that of the control group after 7 days.APTT,PT,TT were significantly prolonged at the time of admission,and kept it for 7 days.A marked relationship was found between APHECHEⅡ and ET,GMP-140,D-dimer levels （P〈0.05）,and a marked relationship was found between PCO2 and ET,GMP-140,D-dimer levels （P〈0.05）.In this study,no relationship between APHECHEⅡ and APTT,PT,TT,and no relationship between PCO2 and APTT,PT,TT was found.Conclusions Coagulation and fibrinolytic abnormalities occur in AECOPD.The severity of coagulation and fibrinolytic markers was related to severe AECOPD.