THE COAGULOPATHY OF HEAT-STROKE ALTERATIONS IN COAGULATION AND FIBRINOLYSIS IN HEAT-STROKE PATIENTS DURING THE PILGRIMAGE (HAJJ) TO MAKKAH
THE COAGULOPATHY OF HEAT-STROKE ALTERATIONS IN COAGULATION AND FIBRINOLYSIS IN HEAT-STROKE PATIENTS DURING THE PILGRIMAGE (HAJJ) TO MAKKAH
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DOI：
10.1097/00001721-199410000-00009
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发表时间：
1994-10-01
影响因子：
1.1
通讯作者：
BOGUS, F
中科院分区：
文献类型：
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作者：
ALMASHHADANI, SA;GADER, AGMA;BOGUS, F
1989-90年连续两个夏天，对麦加朝圣期间诊断出中暑的132名患者进行了止血测量。对照组包括49名患者，所有朝圣者，具有广泛的临床条件，但没有高热或混乱的止血。中暑患者的凝血酶原时间（PT）、活化部分凝血活酶时间（aPTT）和凝血酶时间（TT）明显延长，而血凝酶时间（RT）正常，血浆抗凝血酶Ⅲ（AT-Ⅲ）、凝血因子Ⅴ、蛋白C和S、纤溶酶原激活物抑制物（派）和血小板计数明显降低，血浆血小板计数明显下降。（iii）血浆因子VIII、组织纤溶酶原激活物（t-PA）和血清FDP增加;（iv）血浆纤维蛋白原、纤溶酶原、α（2）-抗纤溶酶和因子VII和X无显著变化。中暑患者被分为有出血症状和没有出血症状。出血者的PT、aPTT和TT延长幅度更大，纤维蛋白原、AT-III、因子V、VIII和X、纤溶酶原、α（2）-抗纤溶酶和血小板计数显着减少。Logistic回归和判别分析表明，AT-III是与中暑最相关的参数，并且足以预测其发生，无论是否发生出血。结果表明，激活的止血机制，消耗性的性质，定期伴随中暑，并强调了生理作用的AT-III在检查这个激活过程。
Haemostatic measurements were undertaken in 132 patients diagnosed with heat stroke during the pilgrimage to Makkah, in two successive summers of 1989-90. The control group comprised 49 patients, all pilgrims, with a wide range of clinical conditions, but without hyperpyrexia or deranged haemostasis. Heat stroke patients showed (i) significant prolongation of the prothrombin (PT), activated partial thromboplastin (aPTT) and thrombin times (TT) but normal reptilase time (RT); (ii) significant reduction in plasma levels of antithrombin III (AT-III), factor V, proteins C and S, plasminogen activator inhibitor (PAI) and platelet count; (iii) increase in plasma factor VIII, tissue plasminogen activator (t-PA) and serum FDP; (iv) no significant changes in plasma fibrinogen, plasminogen, alpha(2)-antiplasmin and factors VII and X. Heat stroke patients were then grouped into those with and those without bleeding symptoms. Bleeders showed greater prolongation of the PT, aPTT and TT and significant reductions in fibrinogen, AT-III, factors V, VIII and X, plasminogen, alpha(2)-antiplasmin and platelet count. Logistic regression and discriminant analysis showed that AT-III was the parameter associated most with heat stroke and reliable enough to predict its occurrence, whether or not bleeding occurred. The results indicate that activation of the haemostatic mechanism, consumptive in nature, regularly accompanies heat stroke and highlights the physiological role of AT-III in checking this activation process.