Plasminogen activator inhibitor 1 promotes a poor prognosis in sepsis-induced disseminated intravascular coagulation
Plasminogen activator inhibitor 1 promotes a poor prognosis in sepsis-induced disseminated intravascular coagulation
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DOI：
10.1532/ijh97.05190
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发表时间：
2006-12-01
影响因子：
2.1
通讯作者：
Sakata, Yoichi
中科院分区：
文献类型：
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作者：
Madoiwa, Seiji;Nunomiya, Shin;Sakata, Yoichi
脓毒症引起的弥散性血管内凝血（DIC）是一种严重的疾病，因为它与多器官功能障碍的发展密切相关。我们比较了 117 名脓毒症诱发的 DIC 患者和 1627 名非脓毒症 DIC 患者的分子纤溶标志物。脓毒症诱发的 DIC 病例中纤维蛋白原、纤维蛋白降解产物和 D-二聚体的水平显着低于非脓毒症 DIC 病例。在脓毒症 DIC 病例中，血浆纤溶酶原激活物抑制剂 I (PAI-1) 水平显着高于非脓毒症 DIC 病例。脓毒症 DIC 病例中 D-二聚体水平与血浆 PAI-1 水平呈负相关。 PAI-1 水平 > 90 ng/mL 的脓毒症 DIC 患者的多器官功能障碍评分显着高于 PAI-1 水平 < 30 ng/mL 的组。 PAI-1 水平 > 90 ng/mL 的组在 DIC 诊断后 28 天的 Kaplan-Meier 生存函数显着低于其他组。在多变量分析中，诊断 DIC 时的血浆 PAI-I 水平是败血症诱发的 DIC 死亡的独立危险因素（风险比，1.012；P =.008）。这些数据表明，血浆 PAI-1 在脓毒症 DIC 病例中维持 DIC 方面发挥着重要作用，并导致此类患者的多器官衰竭和生存率降低。
Sepsis-induced disseminated intravascular coagulation (DIC) is a serious condition because it is closely linked to the development of multiple organ dysfunctions. We compared molecular fibrinolysis markers for 117 patients with sepsis-induced DIC and 1627 patients with nonseptic DIC. Levels of fibrinogen and fibrin degradation products and D-dimer were significantly lower in sepsis-induced DIC cases than in nonseptic DIC cases. In septic DIC cases, plasma plasminogen activator inhibitor I (PAI-1) levels were significantly higher than in nonseptic DIC cases. D-dimer levels were negatively correlated with plasma PAI-1 levels in septic DIC cases. Multiple Organ Dysfunction Scores were significantly higher in septic DIC patients with PAI-1 levels > 90 ng/mL than in the group with PAI-1 levels < 30 ng/mL. The Kaplan-Meier survival functions until 28 days after DIC diagnosis were significantly lower in the group with PAI-1 levels > 90 ng/mL than in the other groups. In a multivariate analysis, plasma PAI-I levels at DIC diagnosis were an independent risk factor for mortality in sepsis-induced DIC (hazard ratio, 1.012; P =.008). These data suggest that plasma PAI-1 plays an important role in sustaining DIC in septic DIC cases and contributes to multiple organ failure and decreased survival in such patients.