老年肺炎对凝血功能的影响

目的观察凝血及纤溶指标在老年肺炎患者中的表达水平、临床意义及与预后关系。方法回顾性收集复旦大学附属华东医院2007年12月-2012年4月收治的肺炎患者，以同时期健康体检者为对照组，查阅病史、分析凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、D-二聚体（D—D）水平、血小板计数（PLT）、血小板压积（PCT）、平均血小板体积（MPV）、血小板分布宽度（PDW）。结果共收集168例老年肺炎，男108例，女60例，年龄（60～90）岁，平均年龄（76．9±7．6）岁。以老年健康体检者为对照组68例，其中男52例，女16例，年龄（60～90）岁，平均年龄（75．1±7．0）岁。肺炎组PT、APTT、FIB、D-D、PCT和PDW较对照组升高（P〈0．05），而MPV较对照组降低（P〈0．05），差异有统计学意义。肺炎组中死亡组FIB、D—D和PLT较存活组升高（P〈0．05），差异有统计学意义。肺炎组高D-D组死亡率较低D—D组升高（（P〈0．05），差异有统计学意义。结论老年肺炎患者凝血系统活性增高，继发性纤溶活性增强，抗凝功能降低，存在高凝状态。观察血浆D—D及FIB水平的变化有助于判断老年肺炎的预后和临床疗效。

The relationship between the plasma levels of coagulation, fibrinolytic function and prognosis in elderly patients with pulmonary infection

Objective To investigate the relationship between blood levels of coagulation markers and pathophysiological characteristics as well as prognosis in patients with pulmonary infection. Methods Medical records of patients with pulmonary infection from December 2007 to April 2012 were retrospectively reviewed. Healthy subjects at the same period were selected as the control group. Clinical characteristics and coagulation markers such as fibrinogen （FIB）, D-dimer （D-D）, prothrombin time （PT）, activated partial thromboplastin time （APTT） and platelet count （PLT） were collected. Comparisons were made between different groups. Results One hundred and sixty-eight hospitalized pulmonary infection patients （108 males, mean age 76.9＋7.6 years） were involved. 68 healthy individuals （52 males, mean age 75.1~7.0 years） were in the control group. The data of clinical parameters and coagulation markers were reviewed. The plasma levels of PT, APTT, FIB, D-D, PCT and PDW in patients with pulmonary infection were significantly higher than those in the normal controls （P 〈 0.05）. The plasma levels of MPV in group of patients with pulmonary infection were significantly lower than that in the normal controls （P〈0.05）. There were statistically significant difference in the plasma levels of FIB, D-D, and PLT between the death group and survival group in the pulmonary infection group （P〈 0.05）. The mortality rate of the higher level of D-D group in the pulmonary infection group was significantly higher than that in the lower level of D-D group （P〈0.05）. Conclusion The state of hypercoagulability, secondary hyperfibrinolysis and low anticoagulation occurred in patients with pulmonary infection. D-dimer level is an independent risk factor in the prognosis of pulmonary infection patients.