The abnormalities of coagulation and fibrinolysis in acute lung injury caused by gas explosion
The abnormalities of coagulation and fibrinolysis in acute lung injury caused by gas explosion
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DOI：
10.1002/kjm2.12262
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发表时间：
2020-07-09
影响因子：
3.3
通讯作者：
Ren, Wen-Jie
中科院分区：
文献类型：
--
作者：
Tian, Lin-Qiang;Guo, Zhi-Hao;Ren, Wen-Jie
瓦斯爆炸引起的急性肺损伤（ALI）是一种常见的肺损伤，其发生机制值得深入研究。具体而言，凝血和纤溶异常在这一过程中的作用尚未确定。推测凝血和纤溶功能异常可能是瓦斯爆炸致急性肺损伤的重要原因。将74例瓦斯爆炸伤患者根据是否发生ALI分为ALI组和非ALI组。在24 h内收集凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）和血小板计数（PLT）结果，并进行组间比较。建立Sprague道利大鼠瓦斯爆炸致ALI模型，采用HE染色和组织病理学评分进行损伤评价。收集支气管肺泡灌洗液（BALF），采用酶联免疫吸附法（ELISA）检测凝血酶-抗凝血酶复合物（达特）、组织因子（TF）、组织因子途径抑制物（TFPI）和纤溶酶原激活物抑制物-1（派-1）的水平。与非ALI组相比，ALI组患者PT较短、APTT较长、FIB浓度升高、PLT数量减少。HE染色可见ALI大鼠肺泡内红细胞增多，肺间质在2 h内增厚，72 h达高峰。BALF中达特/TF持续升高至第7天，派-1在24 h和第7天后升高。TFPI在2 h和24 h后升高，72 h后下降。肺组织凝血、纤溶功能异常在瓦斯爆炸致ALI中起一定作用。
Acute lung injury (ALI) caused by gas explosion is common, and warrants research on the underlying mechanisms. Specifically, the role of abnormalities of coagulation and fibrinolysis in this process has not been defined. It was hypothesized that the abnormal coagulation and fibrinolysis promoted ALI caused by gas explosion. Based on the presence of ALI, 74 cases of gas explosion injury were divided into the ALI and non-ALI groups. The results of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), and platelet count (PLT) were collected within 24 hours and compared between the groups. ALI models caused by gas explosion were established in Sprague Dawley rats, and injuries were evaluated using hematoxylin and eosin (HE) staining and histopathological scoring. Moreover, the bronchoalveolar lavage fluid (BALF) was collected to examine thrombin-antithrombin complex (TAT), tissue factor (TF), tissue factor pathway inhibitor (TFPI), and plasminogen activator inhibitor-1 (PAI-1) levels by enzyme-linked immunosorbent assay (ELISA). The patients in ALI group had shorter PT and longer APTT, raised concentration of FIB and decreased number of PLT, as compared to the non-ALI group. In ALI rats, the HE staining revealed red blood cells in alveoli and interstitial thickening within 2 hours which peaked at 72 hours. The levels of TAT/TF in the BALF increased continually until the seventh day, while the PAI-1 was raised after 24 hours and 7 days. The TFPI was elevated after 2 hours and 24 hours, and then decreased after 72 hours. Abnormalities in coagulation and fibrinolysis in lung tissues play a role in ALI caused by gas explosion.