肿瘤坏死因子α、白细胞介素6、磷脂酶A2、血小板活化因子与重症胸腹损伤凝血功能障碍的相关性

Correlation between tumor necrosis factor-α, interleukin-6, phospholipase A2, platelet-activating factor and coagulation disorders in severe chest-abdominal injury

目的 探讨肿瘤坏死因子α （TNF-α）、白细胞介素6（IL-6）、磷脂酶A2（PLA2）和血小板活化因子（PAF）与重症胸腹损伤凝血功能障碍的相关性与机制.方法 收集2009年1月至2013年6月就诊,创伤指数（TI）≥17分,除外合并颅脑损伤及在急诊死亡的胸腹损伤患者112例（损伤组）,在救治同时检查血小板计数（PLT）、血浆D-二聚体（D-D）、凝血酶原时间（PT）、TNF-α、IL-6、PLA2、PAF,对检验结果进行相关性分析.并与同期42例健康体检者（对照组）比较.结果 与对照组比较,损伤组PLT显著降低[（73.14±32.59）×10^9/L比（191.52±23.31）× 10^9/L],血浆D-D、PT则显著升高[（1 893.87±508.72） U/L比（105.78±44.53） U/L、（38.42±12.85）s比（9.57±4.53）s],差异有统计学意义（P＜0.01）.与对照组比较,损伤组TNF-α、IL-6、PLA2、PAF均显著升高[（39.61±13.09） μg/L比（1.28±0.59）μg/L、（436.83±113.86） μg/L比（63.93±41.49） μg/L、（48.35±12.26） μg/L比（7.47±5.27） μg/L、（15 969.31±4 031.65）ng/L比（3 823.45±529.72）ng/L],差异有统计学意义（P＜0.01）.重症胸腹损伤患者就诊时,PLT与TNF-α、IL-6、PLA2、PAF之间r值均小于-0.895 1,呈负相关,D-D与TNF-α、PLA2及PT与IL-6、PAF之间r值均大于0.931 4,呈正相关.结论 TNF-α、IL-6、PLA2、PAF可能参与了重症胸腹损伤凝血功能障碍的发生,对TNF-α、IL-6、PLA2、PAF早期干预,或可能改善凝血功能障碍,提高生存率.

Objective To investigate the correlation between tumor necrosis factor-α （TNF-α）,interleukin-6 （IL-6）,phospholipase A2（PLA2）,platelet activating factor （PAF） and the coagulation disorder in severe chest-abdominal injury,and to study the effect of these factors on it.Methods One hundred and twelve subjects with severe chest-abdominal injury were collected from January 2009 to June 2013 （injury group）,of whom the trauma index were all above or equal to 17 points,and as the rescue and treatment were in progress the patients were examined platelet count （PLT）,D-dimer （D-D）,prothrombin （PT）,TNF-α,IL-6,PLA2 and PAF for correlation analysis.Forty-two healthy people were selected as control group.Results Compared with that in control group,PLT was decreased [（73.14 ± 32.59） × 10^9/L vs.（191.52 ± 23.31） × 10^9/L],and D-D,PT were increased[（1 893.87 ± 508.72） U/L vs.（105.78 ± 44.53） U/L,（38.42 ± 12.85） s vs.（9.57 ± 4.53） s] in injury group,and there was significant difference （P 〈 0.01）.Compared with that in control group,TNF-α,IL-6,PLA2,PAF were increased in injury group [（39.61 ± 13.09） μg/L vs.（1.28 ±0.59） μg/L,（436.83 ± 113.86） μg/L vs.（63.93 ±41.49） μg/L,（48.35 ± 12.26） μg/L vs.（7.47 ± 5.27） μ g/L,（15 969.31 ± 4 031.65） ng/L vs.（3 823.45 ± 529.72） ng/L],and there were significant differences （P 〈 0.01）.PLT was negatively correlated with TNF-α,IL-6,PLA2,PAF （r 〈-0.895 1）,D-D was positively correlated with TNF-α,PLA2,and PT was positively correlated with IL-6,PAF （r 〉0.931 4）.Conclusions TN F-α,IL-6,PLA2 and PAF all participate in the process of the blood coagulation disorder in severe chest-abdominal injury.The prophase interference in TNF-α,IL-6,PLA2 and PAF is possible to improve the coagulation dysfunction.