Toh Julien M H, Ken-Dror Gie, Downey Colin, Abrams Simon T
aLiverpool College bDepartments of Biostatistics cDepartment of Clinical Infection, Microbiology and Immunology, University of Liverpool dDepartment of Blood Sciences, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
Blood Coagul Fibrinolysis. 2013 Dec;24(8):839-43. doi: 10.1097/MBC.0b013e3283646659.
Sepsis is associated with systemic inflammatory responses and induction of intravascular fibrin formation. Our aim is to investigate whether three fibrin-related markers (FRM) reflect the extent of coagulation activation in vivo and evaluate their clinical usefulness in identifying as well as monitoring patients with sepsis. Fibrin-degradation products (FDP), D-dimer and soluble fibrin monomer assays were measured on plasma samples from patients in the ICU with sepsis (n = 37), systemic inflammatory response syndrome (SIRS) (n = 35) and healthy individuals (n = 15). The levels were correlated with each other and also with fibrinogen, prothrombin time, platelets and antithrombin III. Clinical correlation was also performed for the diagnosis of sepsis and longitudinal monitoring for survival or death.There was strong correlation between the three FRM (r = 0.38-0.93, P < 0.0001) with only fibrin monomer correlating significantly with prothrombin time, fibrinogen and platelet levels. Clinically, all three FRM could discriminate between patients with sepsis, SIRS and healthy individuals with FDP, and D-dimer showing statistical significance (P < 0.05). No FRM predicted outcome from a single measurement but FDP was significantly able to predict patient survival from serial samples [mean FDP (μg/ml) from 35.36 to 21.37 (first to third ICU-day), P < 0.05]. Fibrin monomer appears the most sensitive indicator of coagulation activation, whereas D-dimer and FDP levels can significantly differentiate ICU patients with sepsis from those without. In addition, FDP would be preferable for monitoring with its statistically significant time-dependent prediction of survival or death from sepsis.
脓毒症与全身炎症反应及血管内纤维蛋白形成的诱导有关。我们的目的是研究三种纤维蛋白相关标志物（FRM）是否反映体内凝血激活的程度，并评估它们在识别和监测脓毒症患者方面的临床实用性。对来自重症监护病房（ICU）的脓毒症患者（n = 37）、全身炎症反应综合征（SIRS）患者（n = 35）和健康个体（n = 15）的血浆样本进行纤维蛋白降解产物（FDP）、D - 二聚体和可溶性纤维蛋白单体检测。这些水平相互之间以及与纤维蛋白原、凝血酶原时间、血小板和抗凝血酶III均存在相关性。还对脓毒症的诊断以及生存或死亡的纵向监测进行了临床相关性分析。三种FRM之间存在强相关性（r = 0.38 - 0.93，P < 0.0001），只有纤维蛋白单体与凝血酶原时间、纤维蛋白原和血小板水平显著相关。临床上，所有三种FRM都能区分脓毒症患者、SIRS患者和健康个体，FDP和D - 二聚体具有统计学意义（P < 0.05）。单次测量没有FRM能预测预后，但FDP能够从系列样本中显著预测患者生存情况[平均FDP（μg/ml）从35.36降至21.37（从入住ICU第一天到第三天），P < 0.05]。纤维蛋白单体似乎是凝血激活最敏感的指标，而D - 二聚体和FDP水平能显著区分有脓毒症的ICU患者和无脓毒症的患者。此外，FDP因其对脓毒症生存或死亡具有统计学意义的时间依赖性预测，更适合用于监测。
