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目的:观察连续性血液净化治疗多器官功能障碍综合征(MODS)患者过程中血浆组织因子(TF)、组织因子途径抑制物(TFPI)的变化,并分析影响其变化的相关因素。方法:16例MODS患者随机分为两组,一组给予无肝素连续性静脉-静脉血液透析滤过(CVVHDF)治疗,另一组给予普通肝素抗凝的CVVHDF治疗。观察患者行CVVHDF治疗8h过程中的变化,在治疗0、15min、1h、2h、8h时检测血浆TF及TFPI水平,同时测定血清肿瘤坏死因子(TNF-α)、IL-1β水平,并分析影响TF、TFPI水平变化的相关因素。结果:MODS患者TF、TFPI水平较正常对照组明显升高(P<0.01),TFPI/TF水平较正常对照组显著降低(P<0.01)。CBP治疗过程中,两组患者血浆TF呈下降趋势,而TFPI呈上升趋势。TFPI/TF水平随着CBP时间的延长呈上升趋势。肝素组TFPI/TF上升幅度更为明显,与无肝素组比较差异有统计学意义(P<0.05)。无肝素组CBP治疗MODS患者不同时间点血清TNF-α、IL-1β与血浆TF均呈正相关(P<0.05)而在肝素组无明显相关(P>0.05)。结论:MODS患者分泌TF、TFPI增加,TFPI/TF降低,CBP可部分改善TFPI/TF比例,与CBP清除TNF-α与IL-1β相平行。肝素可增加TFPI的分泌。
Objective: To observe the changes of plasma Tissue Factor (TF) and Tissue Factor Pathway Inhibitor (TFPI) in patients with multiple organ dysfunction syndrome (MODS) treated by continuous blood purification and to analyze the related factors affecting the changes. Methods: Sixteen patients with MODS were randomly divided into two groups: one was treated with CVVHDF without heparin and the other with CVVHDF treated with unfractionated heparin. The levels of TF and TFPI in plasma were detected at 0, 15min, 1h, 2h and 8h after treatment with CVVHDF. The levels of TNF-α and IL-1β in serum were also measured and analyzed TF, TFPI level of the relevant factors. Results: The levels of TF and TFPI in MODS patients were significantly higher than those in normal controls (P <0.01). The levels of TFPI / TF in MODS patients were significantly lower than those in normal controls (P <0.01). In the course of CBP treatment, plasma TF decreased and TFPI increased in both groups. TFPI / TF level with the extension of CBP time is on the rise. Heparin group TFPI / TF increased more significantly, compared with the non-heparin group, the difference was statistically significant (P <0.05). The levels of TNF-α and IL-1β in serum of patients with MODS without heparin group were positively correlated with plasma TF (P <0.05) and no significant correlation with heparin group (P0.05). CONCLUSIONS: The secretion of TF, TFPI increased and TFPI / TF decreased in MODS patients. CBP partially improved the ratio of TFPI / TF, which was in parallel with the clearance of TNF-α and IL-1β by CBP. Heparin increases TFPI secretion.