Chierakul Wirongrong, Tientadakul Panatsaya, Suputtamongkol Yupin, Wuthiekanun Vanaporn, Phimda Kriangsak, Limpaiboon Roongrueng, Opartkiattikul Nisarat, White Nicholas J, Peacock Sharon J, Day Nicholas P
Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand.
Clin Infect Dis. 2008 Jan 15;46(2):254-60. doi: 10.1086/524664.
Disseminated intravascular coagulation (DIC) is common among patients with sepsis. Leptospirosis is an important cause of sepsis in tropical areas, and pulmonary hemorrhage associated with thrombocytopenia is the major cause of death, but the coagulopathy in severe leptospirosis has not been further characterized. The aim of this study was to evaluate coagulation factors and the presence of DIC in patients with leptospirosis in northeast Thailand.
We measured plasma concentrations of fibrinogen, D-dimer, thrombin-antithrombin III complexes, and prothrombin fragment 1,2 and evaluated the DIC score in 79 patients with culture-confirmed and/or serologically confirmed leptospirosis and in 33 healthy Thai control subjects.
The median concentrations of fibrinogen, D-dimer, thrombin-antithrombin III complexes, and prothrombin fragment 1,2 were significantly elevated in a cohort of 79 patients with leptospirosis, compared with healthy control subjects (P<or=.001 for all tests). Patients with leptospirosis had significantly longer prothrombin times, longer activated partial thromboplastin times, and lower platelet counts. Thrombocytopenia was present in 38% of case patients and occurred more frequently among patients with culture-negative leptospirosis; in multivariate analysis, it was the only hemostasis factor independently associated with clinical bleeding. Patients who were culture-negative for Leptospira species had higher Acute Physiology and Chronic Health Evaluation II and Sepsis-Related Organ Failure Assessment scores and more bleeding complications. Nearly one-half of patients with leptospirosis had overt DIC as defined by an International Society on Thrombosis and Hemostasis DIC score.
Activation of the coagulation system is an important feature of leptospirosis. Thrombocytopenia is an indicator of severe disease and risk of bleeding.
弥散性血管内凝血（DIC）在脓毒症患者中很常见。钩端螺旋体病是热带地区脓毒症的一个重要病因，与血小板减少相关的肺出血是主要死因，但严重钩端螺旋体病中的凝血病尚未得到进一步明确。本研究的目的是评估泰国东北部钩端螺旋体病患者的凝血因子及DIC的存在情况。
我们检测了79例经培养确诊和/或血清学确诊的钩端螺旋体病患者以及33名健康泰国对照者血浆中的纤维蛋白原、D - 二聚体、凝血酶 - 抗凝血酶III复合物和凝血酶原片段1,2的浓度，并评估了DIC评分。
与健康对照者相比，79例钩端螺旋体病患者队列中纤维蛋白原、D - 二聚体、凝血酶 - 抗凝血酶III复合物和凝血酶原片段1,2的中位浓度显著升高（所有检测P≤0.001）。钩端螺旋体病患者的凝血酶原时间显著延长、活化部分凝血活酶时间延长且血小板计数降低。38%的病例患者存在血小板减少，在培养阴性的钩端螺旋体病患者中更常见；在多变量分析中，它是唯一与临床出血独立相关的止血因子。钩端螺旋体菌种培养阴性的患者急性生理与慢性健康状况评分系统II和脓毒症相关器官功能衰竭评估评分更高，出血并发症更多。近一半的钩端螺旋体病患者根据国际血栓与止血学会的DIC评分标准患有明显的DIC。
凝血系统激活是钩端螺旋体病的一个重要特征。血小板减少是严重疾病和出血风险的一个指标。
