组织因子、组织因子途径抑制物对脓毒症凝血异常的影响

目的探讨脓毒症时组织因子（tissue factor,TF）与组织因子途径抑制剂（tissue factor pathway inhibitor,TFPI）的表达及其平衡对凝血异常的影响。方法昆明小鼠72只采用盲肠结扎穿孔模型（cecal ligation and puncture,CLP）,分为正常组、假手术组和造模组,每组根据不同时间点（2、4、8、12 h）分4个亚组,每个亚组各6只,检测血小板计数和凝血指标,采用ELISA法检测血浆TF和TFPI浓度。结果盲肠结扎穿孔后,造模12 h组PT、TT、APTT和DD显著升高,Fbg和PLT计数显著降低,与正常组及假手术组比较,差异有统计学意义（P〈0.05）。造模2 h组TF与TFPI均显著升高,各组间比较差异有统计学意义（P〈0.05）;且TF浓度随时间呈进行性升高,而TFPI未见进一步升高。结论脓毒症时,血小板减少及TF、TFPI表达增加的失衡可能是诱发凝血异常进而参与MODS发生的关键因素。

Effects of tissue factor and tissue factor pathway inhibitor on sepsis-induced abnormal coagulation

Objective To investigate the effects of tissue factor（TF） and tissue factor pathway inhibitor（TFPI） expression and balance on abnormal coagulation in sepsis.Methods 72 KM mice were performed cecal ligation and puncture（CLP）,and divided into the normal group,sham-operated group and model group.According to the different time points（2,4,8,12 h）,the three group were divided into 4 subgroups respectively,each group had 6 mice.The level of platelet and coagu lation markers were observed,and the blood concentration of TF and TFPI was detected by enzyme-linked immunosorbent assay（ELISA）.Results Compared with normal group and sham-operated group,the concentration of PT,TT,APTT and DD increased significantly,while Fbg and PLT decreased in the model group at 12 h after CLP（P0.05）.The concentration of TF and TFPI increased significantly in the model group at 2 h after CLP,each group had significant differences（P0.05）.With time extension,the concentration of TF continually increased,but the concentration of TFPI showed inversely.Conclusion In sepsis,thrombocytopenia and imbalance of TF and TFPI expression may be key factors induced abnormal coagulation and MODS.