不同严重程度社区获得性肺炎患者凝血与纤溶指标的研究

Coagulation and fibrinolysis markers in patients with different severities of community-acquired pneumonia

目的探讨不同严重程度社区获得性肺炎患者凝血与纤溶指标变化,为该病的临床诊断与治疗提供参考依据。方法选取2013年6月-2016年1月医院收治的社区获得性肺炎患者160例为肺炎组,另选取同期健康者160名为对照组,并根据肺炎严重程度指数(PSI)将肺炎组患者分为高危、中危、低危,比较肺炎组患者与对照组的凝血、纤溶指标。结果肺炎组患者抗凝血酶Ⅲ(AT-Ⅲ)、血小板计数(PLT)、凝血酶时间(TT)均明显低于对照组,纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)高于对照组,差异有统计学意义(P<0.05);肺炎组患者D-二聚体(D-D)、纤维蛋白(原)降解产物(FDPs)、组织纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制物1(PAI-1)、中性粒细胞弹性蛋白酶(NE)等纤溶指标均明显高于对照组(P<0.05);高危、中危、低危患者AT-Ⅲ、PLT、TT依次升高,APTT逐渐降低,组间差异有统计学意义(P<0.05),不同PSI指数患者FIB及PT差异无统计学意义,高危、中危、低危患者D-D、FDPs、t-PA、PAI-1、NE等纤溶指标均依次降低,差异有统计学意义(P<0.05)。结论社区获得性肺炎患者FIB、APTT、D-D、FDPs等凝血、纤溶指标均高于正常水平,且病情越严重,凝血、纤溶指标异常程度越高。

OBJECTIVE To investigate the changes of blood coagulation and fibrinolysis in the development of community acquired pneumonia patients with different conditions,so as to provide reference for clinical diagnosis and treatment of the disease.METHODS A total of 160 cases of patients with community-acquired pneumonia pneumonia were selected in our hospital from Jun.2013 to Jan.2016 as pneumonia group,and the other selected 160 cases of healthy people for the same period in control group,and according to pneumonia severity index（PSI）the pneumonia group was divided into high risk,medium risk,low-risk patients compared with the control group the different conditions of coagulation and fibrinolysis indicators.RESULTS Pneumonia patients antithrombinⅢ（AT-Ⅲ）,platelet count（PLT）,thrombin time（TT）were significantly lower than the control group,but fibrinogen（FIB）,activated partial thromboplastin time（APTT）,prothrombin time（PT）were higher（P〈0.05）.Pneumonia patients of D-dimer（DD）,fibrin（original）degradation products（FDPs）,tissue plasminogen activator（tPA）,plasminogen activator inhibitor-1（PAI-1）,neutrophil elastase（NE）and other fibrinolytic indexes were significantly higher than control group（P〈0.05）.High-risk,medium risk and low risk patients AT-Ⅲ,PLT,TT increased in turn,but APTT gradually decreased（P〈0.05）between groups.Different PSI index patients FIB and PT was no significant difference.High-risk,medium risk and low risk patients D-D,FDPs,t-PA,PAI-1,NE and other fibrinolysis indicators were in turn reduced（P〈0.05）.The community-acquired lung infections in patients with FIB,APTT,D-D,FDPs and other coagulation and fibrinolysis indicators are higher than normal levels,CONCLUSIONand the more severe the disease,the higher the degree of abnormality in coagulation and fibrinolysis indices.