重症胆管炎患者凝血功能改变的特点  

Coagulation changes in acute severe cholangitis patients

作　　者：陈尔真[1] 李宏为[1] 尹浩然[1] 汤耀卿[1] 张圣道[1] 邵慧珍[1] 朱立红[1] 张庆华[1] 

机构地区：[1]上海第二医科大学附属瑞金医院

出　　处：《中国危重病急救医学》1998年第6期350-352,共3页Chinese Critical Care Medicine

摘　　要：目的：探讨重症胆管炎患者凝血功能改变的特点。方法：对２８例急诊入院且ＡＰＡＣＨＥⅡ评分≥１２分的重症胆管炎患者立刻采血，分别测定抗凝血酶Ⅲ（ＡＴⅢ）、血小板颗粒膜蛋白１４０（ＧＭＰ１４０）、血管性假性血友病因子（ｖＷＦ）、纤维蛋白原（Ｆｇ）、组织型纤溶酶原激活物（ｔＰＡ）、纤溶酶原激活物抑制剂（ＰＡＩ）、纤溶酶原（Ｐｌｇ）及α２纤溶酶抑制剂（α２ＰＩ）。结果：所有患者均存在ＡＴⅢ、ｔＰＡ、Ｐｌｇ三者活性的显著降低以及ＧＭＰ１４０、ｖＷＦ、ＰＡＩ的显著升高，Ｆｇ和α２ＰＩ均无显著变化。结论：重症胆管炎患者在疾病的早期已存在明显的凝血功能紊乱，表现为在凝血与纤溶被激活的同时伴有纤溶受抑，凝血与纤溶间的平衡被破坏而产生高凝状态，以及严重的血小板和内皮细胞受损害，结果引起组织器官内广泛的微血栓形成而导致其微循环障碍。Objective:To observe the clinical significance of coagulation changes in acute severe cholangitis patients.Methods:AntithrombinⅢ (ATⅢ),platelet granulate membrane protein140 (GMP140),von Willebrand factor(vWF),fibrinogen (Fg),tissueplasminogen activator (tPA),plasminogen activator inhibitor (PAI),plasminogen (Plg) and α2plasmin inhibitor (α2PI) were measured in 28 consecutive patients (APACHE　Ⅱ≥12) suffering from acute severe cholangitis within 24 hours after emergency admission.Results:All the patients showed a significant decrease in ATⅢ,tPA and Plg activity,accompanied by a significant increase in GMP140,vWF and PAI.But there was no marked changes in Fg and α2PI in patients with acute severe cholangitis.Conclusions:These data indicate that there is a significant coagulation disorder in patients with acute severe cholangitis.It is characterized by activation of both coagulation and fibrinolysis accompanied with inhibition of fibrinolysis,resulting in an imbalance between coagulation and fibrinolysis leading to a hypercoagulation state and damage of both platelet and endothelium.All of which would further cause the diffuse thrombosis and disorder of microcirculation,precipitating organ dysfunction or even failure.

关 键 词：胆管炎 凝血 纤溶 血小板 内皮细胞 

分 类 号：R657.45[医药卫生—外科学]