Soshitova Natalia P, Karamzin Sergey S, Balandina Anna N, Fadeeva Olga A, Kretchetova Anna V, Galstian Gennadiy M, Panteleev Mikhail A, Ataullakhanov Fazoil I
HemaCore LLC, Moscow, Russia.
Blood Coagul Fibrinolysis. 2012 Sep;23(6):498-507. doi: 10.1097/MBC.0b013e328352e90e.
Inflammation in sepsis is associated with hypercoagulation that may lead to thrombosis and disseminated intravascular coagulation. Conventional diagnostic assays are poorly sensitive to procoagulant changes in sepsis. Objectives of the article is to study changes in hemostatic state of septic patients using spatial clot growth assay (currently being developed under the trademark of thrombodynamics) and to compare the sensitivity of this method with the sensitivity of conventional methods. Sixteen patients with hematological malignancies and sepsis were enrolled in the study. All patients had been surveyed for a month following the infection onset. Spatial clot growth assay monitors fibrin clot development in a nonstirred thin layer of platelet-free plasma activated by immobilized tissue factor. Clotting time tests, thromboelastography, D-dimer assays were also performed. Spatial clot growth revealed hypercoagulation in six patients. D-dimer levels increase (with vein thrombosis in one case) was subsequently observed in five of them. D-dimer levels did not increase when spatial clot growth was normal. At the next time point, after spatial clot growth assay showed hypercoagulation, the mean D-dimer concentration was significantly higher than after a normal analysis (457 versus 234 μg/l; P < 0.05); there was no such correlation for other assays. The remaining 10 patients had elevated D-dimer levels on the first day; this either decreased gradually or remained elevated. Spatial clot growth showed normalization in survivors and growing hypocoagulation in nonsurvivors. Measuring spatial clot growth dynamics has potential diagnostic utility for the evaluation of thrombotic risk.
脓毒症中的炎症与高凝状态相关，这可能导致血栓形成和弥散性血管内凝血。传统诊断检测方法对脓毒症中促凝变化的敏感性较差。本文的目的是使用空间凝块生长测定法（目前正在以血栓动力学商标进行开发）研究脓毒症患者止血状态的变化，并将该方法的敏感性与传统方法的敏感性进行比较。16例血液系统恶性肿瘤合并脓毒症患者纳入研究。所有患者在感染发作后均接受了为期一个月的调查。空间凝块生长测定法监测在由固定化组织因子激活的无血小板血浆的非搅拌薄层中纤维蛋白凝块的形成。还进行了凝血时间测试、血栓弹力图分析、D-二聚体检测。空间凝块生长显示6例患者存在高凝状态。随后在其中5例患者中观察到D-二聚体水平升高（1例伴有静脉血栓形成）。当空间凝块生长正常时，D-二聚体水平未升高。在下一个时间点，在空间凝块生长测定显示高凝状态后,平均D-二聚体浓度显著高于正常分析后（457对234μg/l；P<0.05）；其他检测方法不存在这种相关性。其余10例患者在第一天D-二聚体水平升高；这一水平要么逐渐下降，要么持续升高。空间凝块生长显示幸存者恢复正常，非幸存者出现持续的低凝状态。测量空间凝块生长动力学对评估血栓形成风险具有潜在的诊断价值。
