Sonoclot监测ARDS患者凝血功能与PMA的表达的相关性研究

Study on the relationship between PMA expression and abnormal coagulation function in ARDS patients through Sonoclot surveillance

目的用Sonoclot凝血功能分析仪器监测不同程度急性呼吸窘迫综合征(ARDS)患者凝血功能的变化:激活凝血时间(ACT),凝血速率(CR),血小板功能(PF);用流式细胞仪(FCM)监测外周血血小板—单核细胞聚集体(PMA),探讨ARDS患者凝血功能的变化与PMA表达的相关性,研究ARDS患者凝血功能异常风险预测及早期诊断,为早期干预凝血异常提供依据。方法据2012年ARDS柏林定义将ARDS患者分别纳入轻度组32例,中度组28例,重度组27例,于入院24h内采取外周血用FCM检测PMA,同时行Sonoclot凝血功能分析ACT、PF、CR,同步记录各组的APACHEⅡ评分,并选取24名正常人做为实验对照组,探讨不同程度ARDS患者的凝血功能的变化及PMA变化情况。结果 87例ARDS与正常对照组相比较,PMA、APACHEⅡ评分、ACT水平明显升高,CR、PF明显降低(P<0.01)。与正常对照组相比轻度组ACT、CR、PMA的变化无显著性差异(P>0.05),中度组和轻度组比较也有升高,但无显著性差异(P>0.05),中度组和正常对照组有显著性差异(P<0.01);重度组和正常对照组、轻度ARDS中度组比较差异均有统计学意义(P<0.01)。外周血PMA与ACT(r=0.772 6,P<0.01)、PMA与APACHEⅡ评分(r=0.818 8,P<0.01)均呈正相关;PMA与CR(r=0.711 7,P<0.01)呈正相关;PMA与PF呈明显负相关(r=-0.726 6,P<0.01)。结论 ARDS轻度患者早期即有凝血功能的异常及PMA表达,随着病情加重而加重,重度患者变化明显,提示ARDS患者凝血功能异常和病情发展有关,尤其重度患者;PMA随病情变化与APACHEⅡ评分正相关,可作为判断ARDS凝血异常和病情严重程度的一项高危因子;ACT、PF、CR及ARDS患者APACHEⅡ评分相关性较好,而ACT与PMA相关性明显高于CR、PF与PMA相关性,PMA可作为ARDS凝血异常风险预测因子,ACT为早期凝血异常直接反应因子。

Objective To investigate the correlation between the expression changes of PMA and coagulation function in patients with ARDS,study on the coagulation function of patients with abnormal ARDS risk prediction and early diagnosis,provide the basis for early intervention of abnormal coagulation.Methods According to the Berlin 2012 ARDS patients were included in the definition of group 32 cases of mild to moderate group,28 cases,27 cases of severe group,in 24 hours after admission to the peripheral blood detected by FCM PMA and Sonoclot ACT PF analysis,coagulation function,CR,synchronous recorded APACHE score,and selected 24 normal people as the experimental control group,and PMA change to investigate the changes of coagulation function in patients with different degrees of ARDS.Results Compared with the normal control group,87 cases of PMA,APACHE Ⅱ score,ACT levels were significantly increased,CR,PF decreased significantly,and there were statistical significantly differences （P〈0.01）.Compared with the normal control group,ACT group,CR in mild PMA there were no statistical significantly differences （P〉0.05）,moderate group and mild group were also increased,but there were no statistical significantly differences （P〉0.05）,but there were statistical significantly differences between moderate group and normal control group （P 〈0.01）.In severe group and normal control group mild moderate ARDS group were statistical significantly differences （P 〈0.01）.The peripheral blood PMA and ACT （r= 0.772 6,P〈0.01）,PMA and APACHE score （r= 0.818 8,P〈0.01） were positively correlated with CR;PMA （r=0.711 7,P〈0.01） were positively correlated;PMA were negatively correlated with PF （r=-0.726 6,P〈0.01）.Conclusion The coagulation function abnormal of patients with ARDS relate to the progression of the disease,especially severe ARDS patient.PMA is positive correlation with changes in patients with APACHE score,can be used as judgment a high risk factor of abnormal coagulation and ARDS severity degree.