严重创伤患者血浆凝血酶原片段1+2和GMP-140水平与弥散性血管内凝血的关系

目的探讨严重创伤患者血浆凝血酶原片段1+2(F1+2)和血小板α颗粒膜蛋白-140(GMP-140)水平与弥散性血管内凝血(DIC)的关系。方法将76例创伤患者分成轻伤组(ISS评分小于16分,27例)和重伤组(ISS评分大于或等于16分,49例),再把重伤组分为并发DIC组(19例)与未并发DIC组(30例),另30例健康者为健康对照组。对76例创伤患者分别于伤后24h、3d、7d空腹采集外周静脉血,应用酶联免疫吸附(ELISA)法测定血浆凝血酶原片段1+2浓度、用放免法测定GMP-140。结果 24h内轻伤组与重伤组F1+2、GMP-140水平明显高于健康对照组,且重伤组又明显高于轻伤组。非DIC组伤后F1+2、GMP-140水平逐渐降低,DIC组伤后F1+2水平持续升高,24h内GMP-140水平明显高于非DIC组。结论创伤后急性期F1+2、GMP-140升高程度不仅与创伤严重程度有关,而且与创伤后DIC的发生密切相关;急性期外持续测定F1+2水平对预测创伤后DIC的发生具有较高的临床价值。

Plasma prothrombin fragment 1 +2 and GMP-140 levels in severe trauma patients and its relationship with disseminated intravascular coagulation

Objective To investigate plasma prothrombin fragment 1 +2(F1+2) and platelet α-granule membrane protein-140(GMP-140) level in the patients with severe trauma and its relationship with disseminated intravascular coagulation(DIC).Methods 76 cases of trauma were divided into the minor trauma group(ISS score <16,27cases) and the seriously injured group(ISS score ≥ 16,49 cases).Then the seriously injured group was divided into the complicating DIC group(19 cases) and the non-complicating DIC group(30 cases),30 healthy people were as the healthy control group.Fasting peripheral venous blood after injury,at 24 h,3 d,7 d in 76 cases of trauma was collected and detected for plasma concentrations of prothrombin fragment 1 +2 by ELISA and GMP-140 by radioimmunoassay.Results F1+2 and GMP-140(24 h) in the slightly injured group and the seriously injured group were significantly higher than those in the normal control group,and the seriously injured group was significantly higher than the minor injured group.F1+2 and GMP-140 levels after injury in the non-DIC group were decreased gradually,the F1+2 level after injury in the DIC group continued to rise,the GMP-140 level within 24 h was significantly higher than that in the non-DIC group.Conclusion The increased degree of F1+2 and GMP-140 in the posttraumatic acute stage is related not only with the severity degree of trauma,but also with the occurrence of posttraumatic DIC.After the acute phase,continuous determination of F1+2 levels has higher clinical value to predict the occurrence of posttraumatic DIC.