不同菌种(G^+,G^-)所致脓毒症患者凝血系统功能评价

Evaluating the function of coagulation system in sepsis caused by different strains(G^+,G^-)

目的评价革兰阳性菌(gram-positive bacteria,G^+)和革兰阴性菌(gram-negative bacteria,G^-)所致脓毒症患者凝血系统功能情况,为临床上治疗脓毒症提供新的参考。方法按照资料筛选标准,收集新疆石河子大学第一附属医院重症医学科及急诊重症监护室(intensive care unit,ICU)2016-10至2017-07收治的脓毒症患者62例临床资料,根据病原学检查将其分为G^+组(n=28)和G^-组(n=34),以上患者均为单一菌感染;另选同时期来我院体检的30例非感染但有其他基础疾病者为对照组。对三组进行血液标本检测,分别比较三组凝血相关指标[凝血酶原时间(prothrombintime,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)和纤维蛋白原(fibrinogen,FIB)]及血小板计数(platelet count,PLT)、D-二聚体(D-Dimer,D-D)、抗凝血酶Ⅲ(AntithrombinⅢ,ATⅢ)水平。结果 (1)致病菌分析:62例脓毒症患者中,G^+感染45.2%(28/62),其中金黄色葡萄球菌39.3%(11/28)、耐甲氧西林金黄色葡萄球菌(methicillin-resistant staphylococcus aureus,MRSA)28.6%(8/28)、肺炎链球菌21.4%(6/28);G^-感染54.8%(34/62)其中大肠埃希菌35.3%(12/34)、铜绿假单胞菌23.6%(8/34)、鲍曼不动杆菌14.7%(6/34)。(2)凝血功能指标:三组凝血功能四项(PT、APTT、TT、FIB)及PLT、D-D、ATⅢ指标比较,差异均具有统计学意义(P<0.001);进一步两两比较显示,与对照组比较,G^-菌组和G^+菌组血液中PLT、FIB和ATⅢ水平均显著降低,而PT、APTT和TT时间得到明显延长,D-D水平显著升高,差异均具有统计学意义(P<0.05);与G^+菌组比较,G^-菌组血液中PLT、FIB和ATⅢ水平均显著降低,而PT和APTT时间延长明显,D-D水平显著升高,差异均具有统计学意义(P<0.05)。结论脓毒症患者常存在显著凝血障碍,与G^+菌感染者比较,G^-菌感染的脓毒症患者凝血功能障碍程度更为严重,因此在临床治疗脓毒症时,应给予密切关注。

Objective The objective of this study was to evaluate the coagulation system in sepsis patients caused by gram-positive bacteria （G^＋） and gram-negative bacteria （G^-）, in order to provide reference for clinical treatment of sepsis. Methods Clinical data of 62 cases of sepsis patients treated in the intensive care unit （ICU）, the First Affiliated Hospital of Shihezi University from October 2016 to July 2017 were collected according to the screening criteria. Based on the sputum specimens, they were divided into G^＋ group （n=28） and G^- group （n=34）; both groups had single bacterial infection. 30 non-infected patients examined in the same hospital were selected as the control group. Their blood samples were tested, and the coagulation index [thrombin time （TT）, prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （FIB）], platelet count （PLT）, D-Dimer （D-D） and Antithrombin Ⅲ （AT Ⅲ） in the three groups were compared. Results （1） Pathogenic bacteria： Of the 62 cases of sepsis, G^＋ infection was 45.2% （28/62）, of which Staphylococcus aureus accounted for 39.3% （11/28）, methicillin-resistant Staphylococcus aureus （MRSA） 28.6% （8/28）, Streptococcus pneumoniae 21.4% （6/28）; and G^- infection was 54.8% （34/62）, of which Escherichia coli accounted for 35.3% （12/34）, Pseudomonas aeruginosa 23.6% （8/34）, and Baumanii 14.7% （6/34）. （2） Coagulation function index： the four items （PT, APTT, TT, FIB） of the coagulation index and PLT, D-D, AT Ⅲ index in the three groups were compared, and the difference were statistically significant （P〈0.001）. Further comparison showed that the PLT, FIB and AT Ⅲ index in the G^- and G^＋ groups were significantly lower as compared to the control group. While the time of PT, APTT and TT were significantly prolonged, and the level of D-D increased significantly （P〈0.05）; the PLT, FIB and AT Ⅲ index in the G^＋ group were significantly lower as compared to the G^- group. While the time of PT, APTT and TT was significantly prolonged, and the level of D-D increased significantly （P〈0.05）. Conclusions Sepsis patients always have coagulation dysfunction, and compared with those infected with G^＋ bacteria, the disturbances of blood coagulation in patients with G^- infected sepsis is more seriously disturbed. Therefore, it deserves more attention when the sepsis patients are receiving treatment.