Müller-Berghaus G
Behring Inst Mitt. 1986 Feb(79):131-41.
Septicemia is frequently accompanied by changes in the plasmatic as well as cellular coagulation systems and by microclot formation. The occurrence of a hemorrhagic diathesis and microthrombosis is best explained by the syndrome disseminated intravascular coagulation (= consumption coagulopathy). Disseminated intravascular coagulation can be initiated by different agents and by different pathways. The activation of coagulation by endotoxin is well studied; it is mediated by synthesis of tissue factor by monocytes and endothelial cells. The formation of microthrombi is caused by the precipitation of circulating soluble fibrin under the influence of localizing factors, and it is observed under conditions of reduced fibrinolysis activation. Furthermore, thrombocytopenia, thrombocytopathy and endothelial cell damage caused by a direct effect of the toxic agent contribute to the bleeding diathesis.
败血症常伴有血浆及细胞凝血系统的改变以及微血栓形成。出血素质和微血栓形成的发生最好用弥散性血管内凝血综合征（即消耗性凝血病）来解释。弥散性血管内凝血可由不同因素和不同途径引发。内毒素对凝血的激活已得到充分研究；它是由单核细胞和内皮细胞合成组织因子介导的。微血栓的形成是由循环可溶性纤维蛋白在定位因子的影响下沉淀所致，在纤维蛋白溶解激活降低的情况下可观察到。此外，由毒性因子的直接作用导致的血小板减少、血小板病和内皮细胞损伤也促成了出血素质。
