全身炎症反应综合征患者凝血系统功能紊乱的研究

Coagulation dysfunctions in patients with systemic inflammatory response syndrome

目的 研究全身炎症反应综合征 (SIRS)时凝血系统的变化及其对SIRS预后的影响。方法 按照SIRS诊断标准将入住急诊监护病房的患者分为SIRS组 10 0例、非SIRS组 5 0例 ,另选健康正常人 5 0例为对照组。SIRS组又按照预后分为存活组和死亡组。分别检测血小板数 (PLT)、D 二聚体 (DD)、蛋白C、蛋白S(PC、PS)、抗凝血酶Ⅲ (ATⅢ )、血栓调节蛋白 (TM)、组织纤溶酶原激活物(TPA)、纤溶酶原激活物抑制物 (PAI 1)、凝血酶原时间 (PT)、凝血酶时间 (TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原 (FBG) 12项涉及到与凝血功能有关的实验室指标。结果 (1)SIRS组中TT、APTT、PT、DD、TM、PAI 1均高于非SIRS组对照组 (P <0 0 5 ) ;PC、PS、TPA、PLT、FBG均低于非SIRS组及对照组 (P <0 0 5 )。 (2 )ATⅢ在三组中差异无显著性 (P >0 0 5 )。 (3)DD、APTT和PAI 1在SIRS组中的死亡组与存活组相比显著升高 (P <0 0 5 ) ,并与预后有显著相关性 (P <0 0 1)。结论 (1)在SIRS时存在有凝血系统功能紊乱。 (2 )SIRS时凝血系统功能紊乱主要特征表现为各种促凝物质增加 ,机体抗凝物质减少 ,纤溶系统被抑制 ,而纤溶系统抑制在SIRS发生、发展过程中可能起到更加重要的作用。 (3)DD和PAI 1与SIRS患者的预后呈负相关。

Objective To study the effects of coagulation dysfunctions on patients with the development of systemic inflammatory response syndrome (SIRS). Methods All the patients studied were divided into 2 groups: SIRS and non-SIRS according to the criteria for selection of SIRS. The SIRS group included 100 patients and the non-SIRS group 50 patients. A control group included 50 healthy adults. SIRS group was further divided into two subgroups: survivor and non-survivor. Levels of platelet(PLT), D-dimer, protein C(PC), protein S(PS), antithrombin Ⅲ (ATⅢ),thrombomodulin (TM),tissue plasminogen activator (TPA), plasminogen-activator inhibitor (PAI-1), prothrombin test (PT),thrombin time (TT) , activated partial thromboplastin time (APTT) and fibrinogen (FBG) were measured in all the patients and healthy persons. Results (1)Levels of TT, APTT, PT, D-dimer , TM, PAI-1 were significantly higher in SIRS than those in non-SIRS and the control group ( P <0.05).Levels of PC,PS,TPA, PLT, FBG were significantly lower in SIRS group than those in non-SIRS and the control group ( P <0.05).(2) Levels of ATⅢ were not different among SIRS, non-SIRS and the control group ( P >0.05).(3) Survivors levels of D-dimer、APTT and PAI-1 in SIRS group were significantly higher than there in non-survivors ( P <0.05);they were both negatively correlated with the prognosis of SIRS ( P <0.01). Conclusions (1) There are dysfunctions of coagulation in patients with systemic inflammatory response syndrome. (2) Fibrinolytic system plays an important role in the development of SIRS. (3) Levels of PAI-1 and D-dimer are both negatively correlated with the prognosis of SIRS.