A Pathological Clarification of Sepsis-Associated Disseminated Intravascular Coagulation Based on Comprehensive Coagulation and Fibrinolysis Function
A Pathological Clarification of Sepsis-Associated Disseminated Intravascular Coagulation Based on Comprehensive Coagulation and Fibrinolysis Function
复制标题
DOI：
10.1055/s-0040-1713890
复制
发表时间：
2020-09-01
影响因子：
6.7
通讯作者：
Shima, Midori
中科院分区：
文献类型：
--
作者：
Onishi, Tomoko;Nogami, Keiji;Shima, Midori
背景：弥散性血管内凝血(DIC)患者的凝血和纤溶功能动力学因各种基础疾病的病理和严重程度而异。凝血酶-抗凝血酶复合体、纤溶酶-α2-纤溶酶抑制物复合体、纤维蛋白原-纤维蛋白降解产物等常规止血指标不一定能反映DIC的重要病理生理机制。本文旨在通过对脓毒症相关性DIC患者凝血和纤溶功能的综合评估，阐明其发病机制。凝块-纤溶波形分析(CFWA)和凝血酶/纤溶酶生成分析(T/P-GA)测定止血参数。结果CFWA显示最大凝血速度(|min1|)比值轻度升高至中位数1.40(min-max：0.10~2.60)，而最大纤溶速度(|FL-min1|)比值降至0.61(0~1.19)。T/P-GA显示凝血酶峰值(Th-Peak)比值适度下降至0.71(0.22-1.20)，而纤溶酶峰值(PLM-Peak)比值显著下降至0.35(0.02-1.43)。统计比较发现|min1|和Th峰比率之间存在相关性(Rho=0.55，p
Background The functional dynamics of coagulation and fibrinolysis in patients with disseminated intravascular coagulation (DIC) vary due to the pathology and severity of various underlying diseases. Conventional measurements of hemostasis such as thrombin-antithrombin complex, plasmin-alpha 2-plasmin-inhibitor complex, and fibrinogen-fibrin degradation products may not always reflect critical pathophysiologic mechanisms in DIC. This article aims to clarify the pathology of sepsis-associated DIC using assessment of comprehensive coagulation and fibrinolysis.Methods Plasma samples were obtained from 57 patients with sepsis-associated DIC at the time of initial diagnosis. Hemostasis parameters were quantified by clot-fibrinolysis waveform analysis (CFWA) and thrombin/plasmin generation assays (T/P-GA). The results were expressed as ratios relative to normal plasma.Results CFWA demonstrated that the maximum coagulation velocity (|min1|) ratio modestly increased to median 1.40 (min-max: 0.10-2.60) but the maximum fibrinolytic velocity (|FL-min1|) ratio decreased to 0.61 (0-1.19). T/P-GA indicated that the peak thrombin (Th-Peak) ratio moderately decreased to 0.71 (0.22-1.20), whereas the peak plasmin (Plm-Peak) ratio substantially decreased to 0.35 (0.02-1.43). Statistical comparisons identified a correlation between |min1| and Th-Peak ratios ( rho =0.55, p