Spencer D C, Pienaar N L, Atkinson P M
Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.
J Infect. 1988 Mar;16(2):153-61. doi: 10.1016/s0163-4453(88)93972-2.
Disturbances of blood coagulation were studied in 32 consecutive patients with typhoid fever on their admission to hospital. Estimations of prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin degradation products (FDPs), factors VII, VIII and XII, alpha I antitrypsin, plasminogen, CI esterase inhibitor, and platelet counts were performed as well as liver function tests and blood counts. Five patients had laboratory evidence of disseminated intravascular coagulation (DIC) and two had a generalised bleeding disorder which in the other three was inapparent. The platelet count in the group as a whole was low (P less than 0.05) and the FDPs in most cases were mildly elevated. The pre-kallikrein values were depressed in three of the five with DIC, whereas factor XII was not reduced. These results indicate that bleeding disorders in typhoid fever are uncommon. The depression of pre-kallikrein indicates that the DIC is probably triggered by activation of the intrinsic coagulation pathway. Most patients had lymphopenia and monocytopenia but only two had neutropenia.
对32例连续入院的伤寒热患者的凝血功能障碍进行了研究。进行了凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、纤维蛋白降解产物（FDPs）、因子VII、VIII和XII、α1抗胰蛋白酶、纤溶酶原、C1酯酶抑制剂的测定以及血小板计数，同时还进行了肝功能检查和血常规检查。5例患者有弥散性血管内凝血（DIC）的实验室证据，2例有全身性出血性疾病，另外3例不明显。整个组的血小板计数较低（P<0.05），大多数情况下FDPs轻度升高。5例DIC患者中有3例前激肽释放酶值降低，而因子XII未降低。这些结果表明伤寒热中的出血性疾病并不常见。前激肽释放酶的降低表明DIC可能是由内源性凝血途径的激活引发的。大多数患者有淋巴细胞减少和单核细胞减少，但只有2例有中性粒细胞减少。
