创伤性肝损伤患者活化蛋白C水平与凝血功能及预后的相关性  

Correlation between activated protein C level and coagulation function and prognosis in patients with traumatic liver injury

作　　者：张贝克[1] 范永刚[1] 张莹楠 解刚强[1] ZHANG Bei-ke;FAN Yong-gang;ZHANG Ying-nan;XIE Gang-qiang(Department of Hepatobiliary and Pancreatic Aurgery,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471Q03,China;Department of Pediatric Surgery,the First Affiliated Hospital of Henan University of science and technology,Luoyang 471003,China)

机构地区：[1]河南科技大学第一附属医院肝胆胰外科,洛阳471003 [2]河南科技大学第一附属医院小儿外科

出　　处：《肝脏》2022年第2期233-237,共5页Chinese Hepatology

基　　金：河南省科技攻关项目(172102130370)。

摘　　要：目的探究创伤性肝损伤患者中活化蛋白C(aPC)水平变化,并分析其与早期凝血功能障碍、预后的相关性。方法选择2016年3月至2019年7月河南科技大学第一附属医院肝胆外科创伤性肝损伤的患者80例。入院后(到达急诊室)立即收集血样并检测活化蛋白C、蛋白C(PC)、凝血因子、组织纤溶酶原激活剂(t-PA)和D-二聚体。按照损伤严重度评分(ISS)、碱缺失(BD)水平将患者分为4组,即轻伤无显著组织低灌注(ISS<16,BD<6)组、轻伤伴显著组织低灌注(ISS<16,BD>6)组、重伤无显著组织低灌注(ISS>16,BD<6)组和重伤伴显著组织低灌注(ISS>16,BD>6)组。比较各组凝血参数和aPC水平差异。将患者aPC水平分成四分位数,按照aPC水平将患者进行再分组,分别为Q1组(aPC≤2.71)、Q2组(2.71<aPC<4.06)、Q3组(4.06<aPC<6.09)和Q4组(6.09≤aPC)。比较各组凝血参数和凝血因子水平差异。结果重伤伴显著组织低灌注组患者到达急诊室时PT和APTT水平分别为(15.72±0.40)s和(32.95±1.12)s,较其他组明显延长(P<0.05),aPC水平升高[(11.26±2.33)ng/mL]伴PC水平[(75.22±3.50)ng/mL]降低(P<0.05)。Q4组患者PT和APTT时间最长(P<0.05),分别为(16.43±1.02)s和(38.27±5.46)s;Q4组患者凝血因子Ⅴa和Ⅷa水平明显降低(P<0.05),分别为(43.20±5.11)%和(200.17±32.53)%;tPA和D-二聚体水平明显升高(P<0.05),分别为(34.26±4.02)ng/mL和(23.45±5.68)ng/mL;aPC/PC比率与呼吸机相关性肺炎、多器官功能衰竭、急性肺损伤和死亡显著相关(P<0.05)。结论创伤性肝损伤患者在组织灌注不足和严重外伤的情况下更易发生早期凝血功能障碍,并伴随aPC水平显著升高。这一过程可能与aPC抑制凝血因子相关,同时入院时较高的aPC水平预示严重创伤后预后较差。Objective To explore the changes of activated protein C(aPC)level in patients with traumatic liver injury and analyze its correlation with early coagulation dysfunction and prognosis.Methods From March 2016 to July 2019,80patients with traumatic liver injury in the Department of Gastrointestinal Hepatobiliary Surgery in our hospital were selected.After admission(at the emergency room),blood samples were collected and tested for aPC,protein C(PC),coagulation factors,tissue plasminogen activator(t-PA)and D-dimer.According to injury severity score(ISS)and base deficit(BD)levels,patients were divided into 4 groups,named minor injury without significant tissue hypoperfusion(ISS< 16,BD < 6)group,minor injury with significant tissue hypoperfusion(ISS < 16,BD > 6)group,severe injury without significant tissue hypoperfusion(ISS>16,BD <6)group and severe injury with significant tissue hypoperfusion(ISS> 16,BD >6)group.We compared the differences in coagulation parameters and aPC levels in each group.The aPC level of patients were divided into quartiles,then patients were divided into 4 groups according to the aPC level:Q1 group(aPC < 2.71),Q2 group(2.71< aPC < 4.06),Q3 group(4.06< aPC < 6.09)and Q4 Group(6.09 > aPC).The differences of coagulation parameters and coagulation factor levels in each group were compared.Results Compared with other groups,the PT and APTT levels of patients in the severe injury group with significant tissue hypoperfusion when they arrived in the emergency room were(15.72±0.40)s and(32.95±1.12)s,respectively,which were significantly longer than those in the other groups(P<0.05),the level of aPC was increased(11.26±2.33 ng/mL),and the level of AP was decreased(75.22±3.50 ng/mL)(P<0.05).The PT and APTT times of patients in the Q4 group were the longest(P<0.05),which were(16.43± 1.02)and(38.27±5.46)s,respectively.The levels of coagulation factors Va and Ⅷa in the Q4 group were significantly lower(P<0.05),respectively(43.20 ± 5.11)and(200.17 ± 32.53)%,tPA and Ddimer levels were significantly

关 键 词：创伤性肝损伤 凝血功能障碍 活化蛋白C 

分 类 号：R657.3[医药卫生—外科学]