TIME-COURSE OF HEMOSTATIC ABNORMALITIES IN SEPSIS AND ITS RELATION TO OUTCOME
TIME-COURSE OF HEMOSTATIC ABNORMALITIES IN SEPSIS AND ITS RELATION TO OUTCOME
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DOI：
10.1378/chest.103.5.1536
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发表时间：
1993-05-01
期刊：
影响因子：
9.6
通讯作者：
GARCIAAVELLO, A
中科院分区：
文献类型：
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作者：
LORENTE, JA;GARCIAFRADE, LJ;GARCIAAVELLO, A
目的：探讨感染性休克患者凝血和纤溶异常的时间过程及其与预后的关系。患者与方法：对48例连续入住内科重症监护病房（ICU）诊断为感染性休克的患者（诊断标准明确）进行研究。死亡率为25 / 48。平均年龄57±7.3岁。于入院后第1、4、7天采血，测定组织型纤溶酶原激活物抗原（t-PA）、尿激酶型纤溶酶原激活物抗原（u-PA）、纤溶酶原激活物抑制剂抗原（PAI-1）、纤溶酶原、α - 2抗纤溶酶、纤维蛋白原、抗凝血酶III、蛋白C、蛋白S、凝血酶-抗凝血酶复合物（TAT）、d -二聚体、血管性血友病因子相关抗原（vWF:Ag）。结果：所有患者凝血和纤溶系统均有明显异常。有凝血激活和纤维蛋白溶解激活剂和抑制剂升高的迹象。与幸存者相比，非幸存者的蛋白C和抗凝血酶III水平较低，TAT浓度较高。虽然t-PA和PAI-1浓度在幸存者和非幸存者中都很高，但只有幸存者在研究期间表现出这两个参数的逐渐正常化。两组均发现纤溶酶原水平和纤溶酶原/ α 2-抗纤溶酶比较低，仅在幸存者中呈正常化趋势。报告的差异在入院时并不明显。结论：感染性休克以凝血激活和纤溶激活抑制为特征。非幸存者表现出一种特殊的止血特征，其特征是更明显的凝血激活和更强烈的纤维蛋白溶解抑制。在入院时，幸存者和非幸存者之间所研究的所有异常都没有显著差异。在纤维蛋白形成的情况下，非幸存者在高PAI-1血浆浓度决定的纤溶反应中表现出持续的不平衡，这可能是导致他们预后不良的原因。
Objectives: To investigate the time course and the relation to prognosis of coagulation and fibrinolytic abnormalities in patients with septic shock.Patients and Methods: Forty-eight consecutive patients admitted to the medical ICU with the diagnosis of septic shock (diagnosed by defined criteria) were studied. Mortality was 25 of 48. Mean age was 57 +/- 7.3 years. Blood samples were obtained on days 1, 4, and 7 after hospital admission to measure tissue-type plasminogen activator antigen (t-PA), urokinase-type plasminogen activator (u-PA), plasminogen activator inhibitor antigen (PAI-1), plasminogen, alpha2-antiplasmin, fibrinogen, antithrombin III, protein C, protein S, thrombin-antithrombin complexes (TAT), D-dimer, and von Willebrand factor-related antigen (vWF:Ag).Results: All patients showed marked abnormalities in both the coagulation and fibrinolytic systems. There were signs of coagulation activation and elevation of both activators and inhibitors of fibrinolysis. Nonsurvivors showed lower levels of protein C and antithrombin III and higher concentration of TAT than survivors. While both t-PA and PAI-1 concentrations were high in survivors and nonsurvivors, only survivors showed a progressive normalization of both parameters during the study period. Low plasminogen levels and plasminogen/alpha2-antiplasmin ratio were found in both groups, presenting a trend toward normalization only in survivors. The differences reported were not apparent at the time of hospital admission.Conclusions: Septic shock is characterized by coagulation activation and fibrinolysis activation and inhibition. Nonsurvivors present a particular hemostatic profile characterized by a more marked activation of coagulation and a more intense inhibition of fibrinolysis. None of the abnormalities studied was significantly different between survivors and nonsurvivors at the time of hospital admission. In the presence of fibrin formation, nonsurvivors present a maintained imbalance in the fibrinolytic response determined by higher PAI-1 plasma concentration, probably contributing to their poor outcome.