纤维蛋白原浓缩物和因子 XIII 对在体外以白蛋白、明胶、羟乙基淀粉或生理盐水 33% 稀释的血液中血栓弹力图的影响。
The effect of fibrinogen concentrate and factor XIII on thromboelastometry in 33% diluted blood with albumin, gelatine, hydroxyethyl starch or saline in vitro.
作者信息
Schlimp Christoph Johannes, Cadamuro Janne, Solomon Cristina, Redl Heinz, Schöchl Herbert
机构信息
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Workers' Compensation Board (AUVA) Research Centre, Vienna, Austria.
Department of Laboratory Medicine, University Hospital of Salzburg, Salzburg, Austria.
出版信息
Blood Transfus. 2013 Oct;11(4):510-7. doi: 10.2450/2012.0171-12. Epub 2012 Dec 13.
BACKGROUND
Fluid replacement results in dilutional coagulopathy. We investigated the potential role of fibrinogen, factor XIII and a combination of both to reverse dilutional coagulopathy, assessed by thromboelastometry (ROTEM(®)).
MATERIAL AND METHODS
Blood samples from healthy volunteers were analysed undiluted and after 33% dilution in vitro with albumin, gelatine, 130/0.4 hydroxyethyl starch or saline. Diluted samples were incubated with fibrinogen (3 g/70 kg bodyweight equivalent), factor XIII (10,000 IU/70 kg bodyweight equivalent), or a combination of both. Measurements were performed using an extrinsic activated assay (EXTEM(®)) and a functional fibrin polymerisation test (FIBTEM(®)).
RESULTS
Compared with baseline, EXTEM clotting time increased with hydroxyethyl starch, exceeding the upper limit of the reference value. Albumin prolonged clotting time within normal limits. Gelatine did not change clotting time, and saline reduced clotting time. Clot formation time increased in colloids only. Maximum clot firmness of both EXTEM and FIBTEM decreased with all fluids, but was less pronounced in saline. Incubation with fibrinogen had no effect on EXTEM maximum clot firmness but improved FIBTEM maximum clot firmness in saline (P <0.001) and albumin (P <0.05), but not gelatine and hydroxyethyl starch). Factor XIII had no effect on any EXTEM and FIBTEM maximum clot firmness results. Fibrinogen and factor XIII combined did not improve EXTEM maximum clot firmness. Fibrinogen and factor XIII did not change FIBTEM maximum clot firmness in hydroxyethyl starch but improved FIBTEM maximum clot firmness in albumin (P <0.001), gelatine (P <0.01) and saline (P <0.001).
DISCUSSION
ROTEM parameters in dilutional coagulopathy in vitro cannot be improved with factor XIII alone in any tested diluent. The combination of fibrinogen and factor XIII is highly effective in raising FIBTEM maximum clot firmness after dilution with albumin, gelatine and saline back to normal values, but is ineffective in 130/0.4 hydroxyethyl starch.
背景
液体复苏可导致稀释性凝血病。我们通过血栓弹力图（ROTEM®）研究了纤维蛋白原、因子 XIII 以及两者联合应用对逆转稀释性凝血病的潜在作用。
材料与方法
采集健康志愿者的血液样本，未稀释时以及在体外分别用白蛋白、明胶、130/0.4 羟乙基淀粉或生理盐水进行 33%稀释后进行分析。将稀释后的样本与纤维蛋白原（相当于 3 g/70 kg 体重）、因子 XIII（相当于 10,000 IU/70 kg 体重）或两者联合孵育。使用外源性激活试验（EXTEM®）和功能性纤维蛋白聚合试验（FIBTEM®）进行测量。
结果
与基线相比，羟乙基淀粉使 EXTEM 凝血时间延长，超过参考值上限。白蛋白使凝血时间延长但在正常范围内。明胶未改变凝血时间，生理盐水缩短了凝血时间。仅胶体溶液使凝块形成时间增加。EXTEM 和 FIBTEM 的最大凝块硬度在所有液体中均降低，但在生理盐水中降低程度较小。用纤维蛋白原孵育对 EXTEM 的最大凝块硬度无影响，但可改善生理盐水中（P <0.001）和白蛋白中（P <0.05）的 FIBTEM 最大凝块硬度，而对明胶和羟乙基淀粉无作用。因子 XIII 对任何 EXTEM 和 FIBTEM 的最大凝块硬度结果均无影响。纤维蛋白原和因子 XIII 联合应用未改善 EXTEM 的最大凝块硬度。纤维蛋白原和因子 XIII 未改变羟乙基淀粉中 FIBTEM 的最大凝块硬度，但改善了白蛋白中（P <0.001）、明胶中（P <0.01）和生理盐水中（P <0.001）的 FIBTEM 最大凝块硬度。
讨论
在任何受试稀释剂中，单独使用因子 XIII 均无法改善体外稀释性凝血病的 ROTEM 参数。纤维蛋白原和因子 XIII 联合应用在白蛋白、明胶和生理盐水稀释后将 FIBTEM 最大凝块硬度提高至正常水平方面非常有效，但在 130/0.4 羟乙基淀粉中无效。
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