急性创伤性凝血病患者活化蛋白C血管性假血友病因子D-二聚体的动态变化及其临床意义

Dynamic monitoring of changes of activated protein C, von Wiilebrand factor, and D - dimer in acute traumatic coagulopathy patients

目的探讨急性创伤性凝血病（ATC）患者活化蛋白C（APC）、血管性假血友病因子（vWF）、D-二聚体在受伤后不同时间点血浆水平的动态变化规律及其临床意义。方法将40例多发伤患者，根据是否发生ATC分为ATC组20例和非ATC组20例，并引入正常对照组，分别于人院后6h内、24h、48h及72h，采用酶联免疫吸附法（ELISA）检测血浆APC、D-二聚体、vWF含量水平，观察其动态变化。结果多发伤患者血浆APC、vWF、D-二聚体水平均高于正常对照组。ATC组患者APC值持续偏高，非ATC组患者APC有逐渐下降趋势，在48、72h明显下降（P〈0．05）；ATC组患者APC含量各时间点均较非ATC组明显升高（P〈0．05）；ATC组患者D-二聚体、vWF含量各时间点均较非ATC组明显升高（P〈0．05）。两组患者在人院48h后血浆vWF含量均有逐渐下降趋势（P〈0．05）。结论血中APC、vWF及D-二聚体含量对急性创伤性凝血病的早期诊断、发展趋势及评估、预后判断具有一定的临床意义。

Objective To study the clinical changes of activated protein C, yon Willebrand factor, D- dimer in patients with acute traumatic coagulopathy. Methods Forty cases patients with multiple trauma were divided into acute traumatic coagulopathy group （20 patients ） and non - acute traumatic coagulopathy group （20 patients）. In addition,the normal control group was set up. The levels of plasma activated protein C, thrombomodulin and von Willebrand factor, D - dimer were respectively detected by double- antibody sandwich enzyme -linked immunosorbent assay（ELISA） within 6 hours of injury and 24 h, 48 h, 72 h after injury. The regularity of their changes was observed. Results Compared with normal controls, the levels of plasma activated protein C and von Willebrand factor, D - dimer were significantly increased in patients with multiple trauma. The levels of plasma APC were significantly increased in patients with ATC. The levels of plasma APC declined gradually in non - ATC and reached significantly lower levels in 48 h and 72 h after injury compared with non - ATC within 6 h of injury（P 〈 0.05）. The levels of activated protein C and yon Willebrand factor, D -dimer were significantly higher in ATC group than those in non - ATC group （ P 〈 0. 05 ）. The levels of von Willebrand factor in two groups declined gradually in 48 hours and 72 hours after injury compared with the levels within 6 hours of injury（ P 〈 0.05 ）. Conclusion It is very clinical meaningful to assess the prognosis of ATC and to evaluate the development of ATC by measuring the levels of activated protein C,yon Willebrand factor, D - dimer.