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目的观察急性创伤性凝血病(ATC)不同预后患者外周血活化蛋白C(APC)、血管性假血友病因子(vWF)、D二聚体(D-D)水平变化,并探讨其临床意义。方法选取ATC患者119例,根据患者预后不同分为存活组89例、死亡组30例;取两组入院24 h内外周血,酶联免疫吸附法检测血清APC,采用电化学发光检测血浆vWF、D-D;收集患者资料,采用Logistic回归分析ATC患者预后的危险因素。结果存活组入院24 h血清APC为(3.15±1.22)ng/m L、血浆vWF为178.9%±36.3%、血浆D-D为(186.4±39.0)ng/m L;死亡组血清APC为(3.98±1.40)ng/m L、血浆vWF为228.4%±48.7%、血浆D-D为(214.9±32.8)ng/m L,两组比较差异均有统计学意义(P均<0.05)。Logistic回归分析显示,外周血APC(OR=1.492,95%CI 1.313~4.604,P=0.045)、vWF(OR=1.387,95%CI 1.195~3.851,P=0.035)、D-D(OR=1.525,95%CI 1.264~5.175,P=0.043)水平升高是ATC患者预后不良的独立危险因素(P均<0.05)。结论 ATC不良预后患者外周血APC、vWF、D-D水平显著升高,检测三者水平有利于ATC患者的预后判断。
Objective To observe the changes of peripheral blood activated protein C (APC), von Willebrand factor (vWF) and D dimer (D-D) in patients with acute traumatic coagulopathy (ATC) with different prognosis and to investigate its clinical significance. Methods A total of 119 patients with ATC were selected and divided into survival group (n = 89) and death group (n = 30) according to the prognosis of the patients. Serum APC was detected within 24 h after admission in both groups. ELISA was used to detect plasma vWF, DD; collecting patient data, using Logistic regression analysis of risk factors for prognosis of patients with ATC. Results The serum APC was (3.15 ± 1.22) ng / m L, the plasma vWF was 178.9% ± 36.3% and the plasma DD was (186.4 ± 39.0) ng / m L at 24 h after admission in the survival group. The serum APC in the death group was (3.98 ± 1.40) ) ng / m L, plasma vWF was 228.4% ± 48.7% and plasma DD was (214.9 ± 32.8) ng / m L, with significant difference between the two groups (all P <0.05). Logistic regression analysis showed that peripheral blood APC (OR = 1.492,95% CI 1.313-4.704, P = 0.045), vWF (OR = 1.387,95% CI 1.195-3.851, P = 0.035) % CI 1.264 ~ 5.175, P = 0.043) were the independent risk factors for poor prognosis in patients with ATC (all P <0.05). Conclusion APC, vWF and D-D levels in peripheral blood of patients with poor prognosis of ATC were significantly increased. The detection of these three levels was beneficial to the prognosis of patients with ATC.