慢性阻塞性肺疾病急性加重期凝血特征的研究

Study of Chronic Obstructive Pulmonary Disease with Acute Exacerbation of Coagulation Characteristics

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者凝血功能的特征。方法随机选取150例慢性阻塞性肺疾病急性加重期患者(AECOPD组)、同期门诊治疗的COPD稳定期患者100例(COPD稳定组),分别根据肺功能结果分为轻及中度组、重度及极重度组。同时选取健康体检者100例为健康对照组。检测血小板计数(PLT)、凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、D二聚体(D-D)。结果 COPD稳定组和AECOPD组Fib、D-D的结果明显高于健康对照组(P<0.01),AECOPD组Fib、D-D的结果明显高于COPD稳定组(P<0.01),3组间Fib、D-D的水平随病情加重而升高。各亚组内重度及极重度组患者的Fib、D-D分别高于组内轻度及中度组(P<0.01)。AECOPD组轻度及中度亚组的Fib、D-D高于COPD稳定组轻度及中度亚组(P<0.05);AECOPD组重度及极重度亚组患者的Fib、D-D结果明显高于COPD稳定组重度及极重度亚组(P<0.01)。结论 COPD患者存在血栓前状态,Fib、D-D的表达水平随病情严重程度逐渐增高。检测D-D、Fib水平有助于了解COPD的病情严重程度及凝血功能状态。

Objective To investigate the chronic obstructive pulmonary disease exacerbation（AECOPD）in patients with coagulation characteristics. Methods 150 cases chronic obstructive pulmonary disease with acute exacerbation of AECOPD（AECOPD group） and 100 stable COPD patients with out-patient treatment over the same period（stable COPD group） were randomly selected,the patients in AECOPD group were divided into mild and moderate groups,severe and very severe group according to the results of lung function,and 100 patients were selected for the healthy control group, of the platelet count（PLT） ,prothrombin time（PT） ,activated partial thromboplastin time（APTT） ,fibrinogen （Fib）, D dimer（DD） were detected. Results Fib,DD of AECOPD group and stable COPD group were significantly higher than that of the control group（P 〈0.01） ,The Fib and DD of AECOPD group were significantly higher than that of stable COPD group（P 〈0.01）, The Fib and DD levels increased with disease aggravation in the three groups. The Fib,DD in sub-group of severe and very severe group were higher than those in mild and moderate groups （P 〈 0.01 ）. The Fib and DD in mild and moderate subgroups of AECOPD group were higher than those in mild and moderate COPD subgroup of the stable group （P 〈 0.05） ; The Fib and DD in severe and very severe subgroup of AECOPD group were significantly higher than that of severe COPD, especially in severe subgroup of stable group（P 〈0. 01 ）. Conclusion The prothrombotic state probably exists in COPD patients,Fib,DD level increases with the severity of the disease gradually. Detecting DD Fib to some extent helps to understand the severity of COPD and coagulation status.