血栓前体蛋白测定在严重脓毒症中的临床意义

目的　评价血浆血栓前体蛋白( TPP)浓度变化在严重脓毒症中的意义。方法　应用酶联免疫技术测定2 2例严重脓毒症患者TPP浓度及凝血酶原时间( PT)、活化部分凝血激酶时间( APTT)、纤维蛋白原( Fib)、D- 二聚体含量,并与1 0例一般感染组、8例正常对照组进行比较。同时动态观察严重脓毒症患者收入重症监护治疗病房( ICU)后第1、3和5d各项凝血指标,及与感染相关器官衰竭评分系统( SOFA)、简化急性生理评分系统 ( SAPS )、Marshall多器官功能障碍综合征评分进行相关性分析。结果　1严重脓毒症组TPP浓度与D 二聚体含量阳性率显著高于一般感染组和正常对照组( P均<0 .0 5) ,而PT、APTT、Fib在3组间差异均无显著性( P均>0 .0 5)。2严重脓毒症死亡患者的TPP浓度持续升高,与SOFA、SAPS 、Marshall评分呈正相关。结论　TPP可作为严重脓毒症预后及早期高凝状态的诊断指标;与PT、APTT、Fib、D -二聚体相比具有更高的敏感性和特异性。

Clinical significance of detection of thrombus precursor protein in severe sepsis

OBJECTIVE: To evaluate the significance of the changes in plasma thrombus precursor protein (TPP) in severe sepsis. METHODS: Enzyme linked immunoadsorbent assay (ELISA) was used in the determination of plasma TPP in 22 patients with severe sepsis group. Prothrombin time (PT), activated partial thromboplastin time(APTT), fibrin(Fib), D-Dimer were also determined and the values were compared with those obtained from 10 patients with infection and 8 healthy normal controls. At the same time, scores of sepsis related organ failure assessment(SOFA), simplified acute physiology score (SAPSII), Marshall criteria were made respectively in patients with severe sepsis on 1,3,5 days after admission to the ICU. Analysis of correlation between TPP and scores was done. RESULTS: (1)The concentration of TPP and positive rate of D-Dimer in severe sepsis were obviously higher than that in the ordinary infection group and normal contral group (all P<0.05). But there were no differences in levels of PT, APTT, and Fib among three groups. (2)The concentration of TPP rose continuously in nonsurvivors due to severe sepsis, and it was positively correlated with scores of SOFA, SAPSII, Marshall criteria. CONCLUSION: TPP levels showd a higher specificity and sensitivity in detecting hypercoagulability state in severe than D-Dimer, PT, APTT, Fib assay. It can be used as a diagnostic and prognostic parameter for early hypercoagulability states and outcome of severe sepsis.