创伤患者纤维蛋白单体的聚合功能

背景创伤可以引发机体高凝血状态,并可导致显微外科手术失败.目的观察创伤患者治疗前后纤维蛋白单体聚合功能的变化,探索预测创伤后高凝状态和血栓形成的有效辅助手段.设计病例-对照观察,前后对照观察.单位华中科技大学同济医学院协和医院血栓与止血研究室.对象创伤组受检病例为2001-05/2002-01华中科技大学同济医学院协和医院住院的创伤患者34例,男18例,女16例,年龄8～65岁;正常对照组为健康体检者96例,男50例,女46例,年龄21～68岁.所有受检者均无凝血障碍病史,无全身性与凝血相关疾病.方法血浆纤维蛋白单体聚合功能采用血浆纤维蛋白单体聚合功能测定系统进行测定.在蕲蛇毒的作用下,纤维蛋白原转变为纤维蛋白单体并发生聚合反应,伴随纤维蛋白单体聚合反应发生的浊度变化,用光度仪在340 nm连续进行监测,并将电信号输入微机进行分析.创伤组分别于患者创伤后入院时和入院后经过临床清创、手术、缝合、补液及应用抗生素后第3天采集静脉血,测定纤维蛋白单体聚合功能.主要观察指标①纤维蛋白单体聚合速率(反映血浆纤维蛋白原浓度和功能的综合参数).②最大吸光度(反映标本中凝固性血浆纤维蛋白原的量).③纤维蛋白单体聚合速率与最大吸光度的比值(反映血浆纤维蛋白原分子的聚合功能).结果全体受检者均完成相应检测并纳入数据统计中.①创伤组患者纤维蛋白单体聚合反应速率、纤维蛋白原含量、纤维蛋白单体聚合速率与最大吸光度的比值均显著高于正常对照组创伤组0.87±0.31,(5.81±3.22)g/L,4.61±0.97;正常对照组0.61±0.15,(3.36±1.02)g/L,3.93±0.68,P＜0.01].②治疗3 d后,尽管纤维蛋白单体聚合速率、纤维蛋白原含量有所下降,但仍高于正常组3.93±0.68,(4.21±1.93)g/L],而纤维蛋白单体聚合速率与最大吸光度的比值无改变(4.68±1.19).结论创伤患者纤维蛋白原水平增高功能增强.创伤患者机体处于高凝状态,有血栓形成趋势.纤维蛋白单体聚合功能测定可作为创伤后预测高凝状态和血栓形成的有效辅助手段.

Study on the polymerization of fibrin monomer in traumatic patients

BACKGROUND: Microsurgical operation might fail due to trauma-induced hypercoagulability.OBJECTIVE: To observe the changes of polymerization of fibrin monomer after the treatment of trauma so as to explore an effective means for assisting the prediction of post-traumatic hypercoagulability and thrombosis.DESIGN: Case-control observation and self-control study.SETTING: Institute of Thrombus and Hemostasis, the Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology.PARTICIPANTS: Totally 34 traumatic patients were included from those who were admitted to the Union Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, between May 2001 and January 2002. There were 18 males and 16 females aged 8-65 years old. Another 96 healthy people, 50 males and 46 females aged 21-68 years old, who came for routine physical examination were enrolled as normal controls. The history of coagulation impairment, and general and coagulation-related diseases were excluded in all the subjects.METHODS: Polymerization of plasmic fibrin monomer was detected. Fibrinogen would transform into fibrin monomers and display polymerization induced by acutobin. The accompanied changes of the turbidity were dynamically monitored using spectrophotometer at 340 nm; the obtained electrical signals were then input into the computer for statistical analysis. Venous blood samples were collected from traumatic patients immediately after hospitalization and on the 3rd day after the treatment with clinical debridement, surgery, sutures, liquid supplement and administration of antibiotics to determine polymerization of fibrin monomer. MAIN OUTCOME MEASURES: ① The rate of polymerization of fibrin monomer (taken as the comprehensive predictor for the concentration and function of plasmic fibrinogens). ② Maximum absorbency (reflecting the amount of coagulable plasmic fibrinogen in blood specimen). ③ The ratio between the rate of polymerization of fibrin monomer and maximum ab sorbency (reflecting the polymerization of plasmic fibrinogen molecules). RESULTS: All participants completed the corresponding examinations and were brought into data analysis. ① In traumatic group, the rate of fibrin monomer polymerization, the content of fibrinogen, the ratio of polymerization rate to maximum absorbency were all significantly higher than those in normal control group traumatic group: 0.87±0.31, (5.81±3.22) g/L,4.61±0.97; normal control group: 0.61±0.15, (3.36±1.02) g/L, 3.93±0.68,P ＜ 0.01]. ② At treatment of 3 days, although the rate of polymerization and the content of fibrinogen were found slightly declined, they were still higher than those in normal group 3.93±0.68, (4.21±1.93) g/L]; however,the ratio of polymerization rate to maximum absorbency did not change after treatment (4.68± 1.19).CONCLUSION: The content and function of fibrinogen would increase in traumatic patients. Traumatic patients display hypercoagulability characteristics and have thrombosis tendency. Determining the polymerization of fibrin monomer can be taken as an effective means for assisting the prediction of posttraumatic hypercoagulability and thrombosis.