严重下肢创伤患者血浆纤溶酶原激活物抑制物1和抗凝血酶Ⅲ水平变化及弥散性血管内凝血相关性研究

目的探讨严重下肢创伤患者纤溶酶原激活物抑制物1(PAI-1)、抗凝血酶III(ATⅢ)的变化及其与伤后前弥散性血管内凝血(DIC)、DIC等并发症的关系。方法将26例下肢创伤患者分为重伤组(简明损伤定级评分不低于3分,20例)和轻伤组(6例);26例患者又分为前DIC组7例、DIC组3例、其他组16例;26例患者于伤后第1,3,6天空腹采外周静脉血,检测血液PAI-1及ATⅢ水平变化,并与对照组10例健康人比较。结果重伤组和轻伤组PAI-1在伤后第1天明显高于对照组(P<0.01),且重伤组明显高于轻伤组(P<0.05),ATⅢ在伤后第1,3,6天明显低于对照组(P<0.01),且重伤组明显低于轻伤组(P<0.05)。DIC组PAI-1在伤后第1天明显高于前DIC组(P<0.05),而ATⅢ在伤后第1,3天明显低于非前DIC组(P<0.05)。伤后ATⅢ水平与DIC、前DIC的发生呈明显负相关。结论下肢创伤后急性期ATⅢ和PAI-1水平变化与创伤严重程度有关,检测这两项指标对于预测下肢伤患者病情进展及并发症发生情况能提供可靠的实验诊断依据。

Changes of ATIII and PAI-1 levels and their relation with DIC in Patients with Severe Lower Extremities Trauma

Objective To explore the changes of antithrombin Ⅲ（ATⅢ） and plasminogen activator inhibitor（PAI-1） levels and their relativity with the occurrence of Pre-DIC and DIC complications after trauma in the patients with severe lower extremities trauma.Methods Twenty-six patients were divided into severe-injury group（AIS ≥3,20 cases） and minor-injury group（6 cases） with the other 10 healthy peoples as the control group.26 patients were also divided into Pre-DIC group（7 cases）,DIC group（3 cases）and others（16 cases）.Peripheral fasting venous blood was collected for detecting PAI-1 and ATIII on 1,3,6 d in 26 patients and comparing the detection results with the control group.Results The PAI-1 level on post-trauma 1 d in the severe-injury group and minor-injury group was obviously higher than that in the control group（P 0.05）,and the severe-injury group＇s was higher than the minor-injury group＇s（P 0.05）.The ATⅢlevel on 1,3,6 d in the severe-injury group and minor-injury group was significantly lower than that in the control group（P 0.05）,and the severe-injury group＇s was significantly lower than the minor-injury group＇s.The PAI-1 level on 1 d in the DIC group was obviously higher than the Pre-DIC group（P 0.05）,while ATIII level on post-trauma 1,3 d was significantly lower than that in the non DIC group（P 0.01）.The post-trauma ATⅢlevel was negatively related with the occurrence of DIC and Pre-DIC.Conclusion The ATⅢand PAI-1 levels in acute phase after trauma are relevant to the severity of trauma.Detecting these 2 indicators may provide the reliable experimental diagnostic evidence for predicting the disease progress of lower extremities trauma and the occurrence of complications.