蛋白C通路的活化对多发伤患者早期凝血功能及其预后的影响

Influence of activation of activation of protein C pathway on early coagulation and prognosis of multiple trauma patients： analysis of cases

目的探讨蛋白C（PC）通路活化与并发休克的严重多发伤患者早期凝血功能紊乱的相互关系，并探讨Pc通路的活化对其预后的影响。方法将60例多发伤患者，于入院后1h内取静脉血10mL和4mL动脉血，用酶联免疫吸附法（ELISA）检测活化蛋白C（APC）、蛋白C（PC）的血浆水平，测定凝血酶原时间（prothrombin time，PT）、活化部分凝血激酶时间（activated partial ihromboplastin time, APTT），进行动脉血气分析，收集其临床资料。所选患者根据其损伤严重度评分（injuryseverity scor，ISS）及乳酸值，分为4组：ISS〈15和乳酸〈2．0组；ISS〈15、乳酸〉2．0组；ISS〉15、乳酸〈2．0组；ISS〉15、乳酸〉2．0组．根据APC测定值分为APC低值组、中值组及高值组。应用logistic相关曲线分析APC／PC与临床预后（包括ICU住院时间和机械通气时间和VAP发生率及28d病死率）的相关性。结果并发休克的严重创伤组（ISS〉15、乳酸〉2．0）其PT、APTT显著长于无休克的轻伤组（ISS〈15和乳酸〈2．0）（P〈0．01），其APC值显著较高（P〈0．01），PC值下海组较低（P〈0．01）。APC／PC比值高者其ICU住院时间、机械通气时间更长，VAP发生率及28d病死率更高，预后更差。结论早期合并休克的严重多发伤患者更易并发凝血功能紊乱及PC通路活化，其凝血功能紊乱是由Pc通路活化诱导。Pc通路活化的多发伤患者后期更易并发HAP，预后更差。

Objective To study the relationship of activated protein C （APC） with the early coagulation disorder in the acute trauma patients complicated with shock. Methods Arterial blood samples and venous blood samples were collected from 60 multiple trauma patients within one hour after hospitalization to undergo examination of prothrombin time （PT）, activated partial ihromboplastin time （APTT）, APC, protein C （PC）, and blood biochemistry, and arterial blood gas analysis. The patients were divided into 4 groups according to the injury severity seorr （ISS） and value of lactic aeide： group with ISS〈15 and lactic acid〈2.0, group with ISS〈15 and lactic acid 〉2.0, group with ISS〉15 and lactic acid〈2.0, and group with ISS〉15 and lactic acid〉2.0. They could be dividedinto 3 groups according to the APC value in addition. The mechanical ventilation time, ICU hospitalization time, and 28-day mortality were observed. Results The PT and APTT of the group with ISS〉15 and lactic acid〉2.0 groupo were both significant long than those of the group with ISS〈15 and ;actic acid〈2.0 g （both P〈0.05）. The PT and APTT of the group with the highest APC were both significantly longer than those of the group with lthe owest APC （both P 〈0.01）. The patients with high APC/ PC rario had longer mechanical ventilation time and ICU stay time, and higher VAO morditity and 280day mortality （all P 〈0.01）. Conclusion Coagulation disorder is often complicated in the patients with severe multiple trauma, mediated by activation of the PC pathway.