Gando S, Nanzaki S, Sasaki S, Kemmotsu O
Department of Anesthesiology and Intensive Care, Hokkaido University School of Medicine, Sapporo, Japan.
Thromb Haemost. 1998 Jun;79(6):1111-5.
To determine the role of plasma tissue factor on disseminated intravascular coagulation (DIC) in trauma and septic patients, and also to investigate the relationships between tissue factor and various thrombin markers, we made a prospective cohort study. Forty trauma patients and 20 patients with sepsis were classified into subgroups according to the complication of DIC. Plasma tissue factor antigen concentration (tissue factor), prothrombin fragment F1+2 (PF1+2), thrombin antithrombin complex (TAT), fibrinopeptide A (FPA), and D-dimer were measured on the day of admission (day 0), and on days 1, 2, 3, and 4 after admission. The levels of plasma tissue factor in the DIC group were more elevated than those of the non-DIC group in both the trauma and the septic patients. In patients with sepsis, tissue factor levels on days 0 through 4 in the non-DIC group showed markedly higher values than those in the control patients (135 +/- 8 pg/ml). Significant correlations between tissue factor and PF1+2, TAT, FPA, and D-dimer were observed in the DIC patients, however, no such correlations were found in the non-DIC patients. These results suggest that elevated plasma tissue factor in patients with trauma and sepsis gives rise to thrombin generation, followed by intravascular coagulation.
为了确定血浆组织因子在创伤和脓毒症患者弥散性血管内凝血（DIC）中的作用，并研究组织因子与各种凝血酶标志物之间的关系，我们进行了一项前瞻性队列研究。40例创伤患者和20例脓毒症患者根据是否发生DIC并发症被分为亚组。在入院当天（第0天）以及入院后第1、2、3和4天，检测血浆组织因子抗原浓度（组织因子）、凝血酶原片段F1+2（PF1+2）、凝血酶抗凝血酶复合物（TAT）、纤维蛋白肽A（FPA）和D-二聚体。在创伤患者和脓毒症患者中，DIC组的血浆组织因子水平均高于非DIC组。在脓毒症患者中，非DIC组第0至4天的组织因子水平显著高于对照患者（135±8 pg/ml）。在DIC患者中观察到组织因子与PF1+2、TAT、FPA和D-二聚体之间存在显著相关性，然而，在非DIC患者中未发现此类相关性。这些结果表明，创伤和脓毒症患者血浆组织因子升高会导致凝血酶生成，进而引发血管内凝血。
