不同病程的细菌性炎症患者中降钙素原与凝血功能指标的相关性分析

The correlation analysis between PCT and coagulation indexes in patient with different degree inflammation

目的探讨降钙素原(procalcitonin,PCT)对细菌性炎症病程中凝血功能指标变化的判别能力,评价凝血功能与炎症程度的相关性。方法回顾性分析479例不同炎症程度的细菌性感染患者的PCT与凝血功能相关指标(APTT﹑TT﹑PT﹑FIB),统计分析PCT变化与凝血功能指标的相关性。结果按照PCT分组细菌性炎症病程,发现PCT与凝血指标PT﹑APTT﹑FIB﹑TT同向升高,且各组之间PT﹑APTT﹑FIB﹑TT均表现出明显差异(P<0.01)。按照是否发生脓毒血症分组,发现2组之间凝血指标PT和APTT差异明显。脓毒血症早期发生阶段(2<PCT<10),凝血外源性指标PT和凝血内源性指标APTT以及反应纤溶活性指标TT出现了同向的变化,仅FIB与PCT呈相关性(r/P,0.21/0.04),而凝血指标间FIB仅与TT呈负相关(r/P,-0.514/0.00)。重度脓毒血症发生前(PCT<10),凝血指标PT﹑FIB﹑APTT与PCT相关。结论在细菌性炎症不同病程中,凝血指标的差异是存在的;从细菌性感染的早期炎症到重度炎症的脓毒血症发生发展的病程中,凝血指标与PCT同向变化以及相关性提示凝血功能的监测对脓毒血症鉴别和病程进展提示可能有重要意义。

This study designed to evaluate the correlation between coagulation indexes and inflammation by exploring the discriminating power of PCT to the change of coagulation indexes at different degree of inflammation. The difference expression of coagulation indexes （including APTT, TT, PT and FIB） was analyzed retrospectively, and the correlation between changes of PCT and inflammation was statistically analyzed in 479 patients with bacterial infection. Data showed that in groups determined by PCT, the level of PCT elevated accompanying with coagulation indexes （APTT, TT, PT and FIB） in progressive inflammation, and the difference of all coagulation indexes was apparent among the groups （P〈 0.01）. Also, the apparently difference of PT and APTT was found between before- sepsis group and after-sepsis group. In the early period of sepsis （2〈PCT〈10）, the correlation only appeared between FIB and PCT（r=0.21, P=0.04）, and the related indexes of coagulation function PT （exogenous indexes）, APTT （endogenous index） and TT （fibrin activity index） changed in the same direction, but FIB was negatively correlated with TT（r=-0.514, P=0.00）. Before severe sepsis （PCT〈10）, PCT was positively correlated with PT, FIB, and AFFF. In conclusion, the difference of coagulation indexes are exist in patients with different degree of inflammation; From initial inflammation to severs inflammation, the change and correlation between coagulation and inflammation may provide a novel idea that coagulation indexes may be a way to therapy for early-edge sepsis.