Shimizu Michiomi, Konishi Akiko, Nomura Shosaku
First Department of Internal Medicine, Kansai Medical University, Hirakata, Japan,
Int J Gen Med. 2018 Sep 12;11:353-361. doi: 10.2147/IJGM.S173684. eCollection 2018.
Disseminated avascular coagulation (DIC) is the main cause of death among patients with sepsis. In particular, low platelet count is predictive of poor outcome. However, the significance of platelet activation in patients with sepsis-related DIC is poorly understood. To determine the characteristics of platelet-related abnormality in patients with sepsis-related DIC, we assessed the expression levels of several biomarkers.
Plasma levels of biomarkers, including cytokines, chemokines, soluble selectins, platelet-derived microparticles (PDMPs), soluble vascular adhesion molecule 1, and high mobility group box protein 1 were measured by enzyme-linked immunosorbent assay at baseline and after 4, 7, 14, and 21 days of DIC treatment.
Differences in platelet activation and in the elevation of activated platelet-related PDMPs and of soluble P-selectin were seen between patients suffering from sepsis and hematologic malignancy with DIC. In addition, the elevation of interleukin (IL)-6 and thrombopoietin (TPO) was significant in sepsis patients with DIC. Furthermore, IL-6 and TPO promoted platelet activation in vitro.
Assessment of PDMPs, sP-selectin, IL-6, and TPO may be beneficial in the primary prevention of multi-organ failure in sepsis patients with DIC.
弥散性血管内凝血(DIC)是脓毒症患者死亡的主要原因。特别是,血小板计数低预示着预后不良。然而,脓毒症相关DIC患者血小板活化的意义尚不清楚。为了确定脓毒症相关DIC患者血小板相关异常的特征,我们评估了几种生物标志物的表达水平。
在DIC治疗的基线以及第4、7、14和21天,通过酶联免疫吸附测定法测量生物标志物的血浆水平,包括细胞因子、趋化因子、可溶性选择素、血小板衍生微粒(PDMPs)、可溶性血管粘附分子1和高迁移率族蛋白1。
脓毒症合并DIC患者与血液系统恶性肿瘤合并DIC患者在血小板活化以及活化血小板相关的PDMPs和可溶性P选择素升高方面存在差异。此外,脓毒症合并DIC患者中白细胞介素(IL)-6和血小板生成素(TPO)升高显著。此外,IL-6和TPO在体外促进血小板活化。
评估PDMPs、可溶性P选择素、IL-6和TPO可能有助于脓毒症合并DIC患者多器官功能衰竭的一级预防。