Arora M M, Mishra K B, Nair Velu, Bhardwaj J R, Bhalwar Rajvir, Somani B L
Head, Department of Biochemistry, Armed Forces Medical College, Pune - 411 040.
Senior Advisor (Pathology), Military Hospital, Jalandhar Cantt.
Med J Armed Forces India. 2002 Jan;58(1):13-7. doi: 10.1016/S0377-1237(02)80005-3. Epub 2011 Jul 21.
Alterations in coagulation profile viz. platelet count, prothrombin time (PT), partial thromboplastin time with kaolin (PTTK), thrombin time (TT) and fibrinogen were studied in 96 patients (73 males and 23 females) of acute infections. Fibrin/fibrinogen degradation products (FDP) level >25µg fibrinogen equivalent unit (FEU)/ml along-with D-dimer >1.0µg FEU/ml was considered criteria for diagnosis of disseminated intravascular coagulation (DIC). Normal values were established using plasma from 12 healthy voluntary blood donors. Out of these 96 patients, 15 had infection with Gram positive bacteria, 23 with Gram negative bacteria and 38 with Dengue. In 20 patients, nature of infection was not defined. Mean platelet count per cubic millimetre was 2.14 lac in Gram positive infection and 1.74 lac in Gram negative infection (p=0.07). There was no significant difference in other coagulation parameters in Gram positive and Gram negative infection. Platelet counts were low in 71% of Dengue patients but there was no significant alteration in PT, PTTK and TT. None of the Dengue patients had hypofibrinogenemia or DIC though hyperfibrinogenemia was present in 21% of Dengue patients. 20 patients had features of septicemia (Gram +ve 7, Gram -ve 8, undefined 5); 10 had concomitant DIC. DIC was present in additional 4 patients of acute infection without septicemia. PTTK was raised in 60% of the septicemia patients. 20 out of 82 non-DIC acute infection patients had subnormal PTTK. Commonest alteration in 14 DIC patients was raised PTTK with a sensitivity of 78.6% and specificity of 81.7%. Low fibrinogen levels though specific for DIC, were present in only 21.4% of the DIC patients. Combinations of PTTK >38 sec with PT >15 sec or platelet count < 1.5 lac/mmm(3) were good screening tests for DIC and detected 11 and 10 patients out of 14 with three and two false positives respectively.
对96例急性感染患者（73例男性和23例女性）的凝血指标变化进行了研究，这些指标包括血小板计数、凝血酶原时间（PT）、高岭土部分凝血活酶时间（PTTK）、凝血酶时间（TT）和纤维蛋白原。纤维蛋白/纤维蛋白原降解产物（FDP）水平>25μg纤维蛋白原当量单位（FEU）/ml以及D - 二聚体>1.0μg FEU/ml被视为诊断弥散性血管内凝血（DIC）的标准。使用12名健康自愿献血者的血浆确定了正常值。在这96例患者中，15例感染革兰氏阳性菌，23例感染革兰氏阴性菌，38例感染登革热。20例患者的感染性质未明确。革兰氏阳性菌感染患者每立方毫米的平均血小板计数为21.4万，革兰氏阴性菌感染患者为17.4万（p = 0.07）。革兰氏阳性菌和革兰氏阴性菌感染患者的其他凝血参数无显著差异。71%的登革热患者血小板计数较低，但PT、PTTK和TT无显著变化。尽管21%的登革热患者存在高纤维蛋白原血症，但没有登革热患者出现低纤维蛋白原血症或DIC。20例患者有败血症特征（革兰氏阳性菌7例，革兰氏阴性菌8例，未明确5例）；10例伴有DIC。另外4例无败血症的急性感染患者也存在DIC。60%的败血症患者PTTK升高。82例非DIC急性感染患者中有20例PTTK低于正常。14例DIC患者中最常见的变化是PTTK升高，敏感性为78.6%，特异性为81.7%。低纤维蛋白原水平虽然是DIC的特异性指标，但仅在21.4%的DIC患者中出现。PTTK>38秒与PT>15秒或血小板计数<15万/mm³的组合是DIC的良好筛查试验，在14例患者中分别检测出11例和10例，分别有3例和2例假阳性。
