创伤性凝血病血小板功能障碍早期分子标志物的临床研究

Clinical study of early molecular markers of platelet dysfunction in traumatic coagulopathy

目的探究创伤性凝血病(TIC)血小板功能障碍早期分子标志物的临床价值。方法前瞻性选取2019年1月至2020年1月联勤保障部队第九〇八医院收治的90例TIC患者作为研究对象,根据患者发病距入院时间分为6 h内组(n=35)、6~12 h组(n=29)与12 h后组(n=26)。收集患者一般资料,检测患者血小板功能障碍早期分子标志物[血浆凝血酶抗凝血酶复合物(TAT)、纤溶酶-α2纤溶酶抑制物复合物(PIC)、血栓调节蛋白(TM)及组织纤溶酶原激活物-抑制剂1复合物(t-PAIC)],采用Sonoclot凝血及血小板分析仪检测患者血小板功能,分析血栓分子标志物与传统凝血指标及分子标志物的相关性。结果3组患者年龄、性别构成比、国际血栓与止血学会(ISTH)评分、急性生理与慢性健康评分(APACHEⅡ)比较差异均无统计学意义(P>0.05);各组血小板指标、凝血酶原国际标准化比值(INR)、纤维蛋白原(FIB)、血液肌酐比较差异均无统计学意义(P>0.05);12 h后组活化部分凝血活酶时间(APTT)、D-二聚体、激活全血凝固时间(ACT)高于6~12 h组与6 h组,12 h后组TAT、TM、t-PAIC、PIC高于6~12 h组与6 h组,差异有统计学意义(P<0.05);将TIC组患者血小板功能早期分子标志物与传统的凝血指标进行直线相关性分析,TAT、TM、t-PAIC、PIC与APTT、PT、D-二聚体、ACT呈正相关,与血液肌酐、PF呈负相关(P<0.05)。结论血小板功能障碍早期分子标志物在TIC形成及发展中有着重要的参与作用,其中TAT、TM、t-PAIC、PIC分子标志物与凝血指标符合率高,能够用于TIC的早期诊断及干预,具有较高临床价值。

Objective To explore the clinical value of early molecular markers of platelet dysfunction in traumatic coagulopathy(TIC).Methods A prospective selection of 90 TIC patients admitted to No.908 Hospital of Joint Logistics Support Force from January 2019 to January 2020 were selected as the research objects.According to the time between onset and admission,they were divided into groups within 6 hours(n=35),the 6~12 h group(n=29)and the 12 h post group(n=26),general patient data were collected,and early molecular markers of platelet dysfunction including plasma thrombin antithrombin complex(TAT),plasma thrombin antithrombin complex(TAT),Plasmin-α2 plasmin inhibitor complex(PIC),thrombomodulin(TM)and tissue plasminogen activator-inhibitor 1 complex(t-PAIC),using Sonoclot coagulation and platelet analyzer Detect the patient's platelet function and analyze the correlation between thrombus molecular markers and traditional coagulation indicators and molecular markers.Results There were no significant differences in age,sex composition ratio,thrombus and hemostasis score(ISTH),acute physiology and chronic health score(APACHEⅡ)between the three groups(P>0.05);There were no significant differences in platelet index,international normalized ratio(INR),fibrinogen(FIB)and blood creatinine among the groups(P>0.05).Activated partial thromboplastin time(APTT),D-dimer,activated clotting time of whole blood(ACT)in the 12 h post group were higher than those in the 6-12 h group and 6 h group,TAT,TM,t-PAIC,PIC were higher than those in the 6-12 h group and 6 h group,the differences were statistically significant(P<0.05).The linear correlation analysis was performed between the early molecular markers of platelet function and traditional coagulation indexes in the TIC group,TAT,TM,t-PAIC,PIC were positively correlated with APTT,PT,D-dimer,and ACT,and were positively correlated with blood creatinine and PF negative correlation(P<0.05).Conclusion Early molecular markers of platelet dysfunction play an important role in the formation and development of TIC.Among them,TAT,TM,t-PAIC,PIC molecular markers have a high coincidence rate with coagulation indicators,can be used for early diagnosis and intervention of TIC,and have high clinical value.