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目的探讨肿瘤坏死因子(TNF)-α和脂多糖水平与重症闭合性损伤患者凝血功能障碍的相关性。方法随机选取2012年1月至2014年1月诊治的重症闭合性损伤患者65例,出血量>2 000 ml,创伤指数>17,检测所有患者血清TNF-α和脂多糖水平及凝血功能指标[包括凝血酶原时间(PT)和部分活化凝血酶原时间(APTT)以及血小板(PLT)],采用线性相关分析上述指标的相关性;并根据患者凝血功能指标异常程度分两组[当PT>(18.00±5.23)s和APTT>(45.00±9.20)s时,定义为凝血功能明显异常]:凝血功能明显异常组(46例)和凝血功能轻度异常组(19例)。比较两组TNF-α和脂多糖水平的差异。结果凝血功能明显异常组患者血清TNF-α和脂多糖水平分别为(41.28±8.64)ng/ml和(374.23±121.23)U/L,均明显高于凝血功能轻度异常组[(28.64±5.61)ng/ml,(302.65±107.69)U/L,P均<0.01];进一步线性回归分析发现,脂多糖与APTT、PT呈正相关(r=0.745,0.871,P均<0.01),与PLT呈负相关(r=-0.815,P<0.01);TNF-α与APTT、PT呈正相关(r=0.894,0.928,P均<0.01),与PLT呈负相关(r=-0.785,P<0.01)。此外,痊愈患者APTT、PT水平明显低于死亡患者(P均<0.01),PLT水平明显高于死亡患者(P<0.01)。结论 TNF-α和脂多糖与重症闭合性损伤患者凝血功能障碍密切相关,两者可能通过促进血小板及其他凝血因子的大量消耗,参与其凝血功能障碍的发生发展,早期检测TNF-α和脂多糖水平并给予相应治疗将有助于改善患者凝血功能。
Objective To investigate the correlation between tumor necrosis factor (TNF) -α and lipopolysaccharide in patients with severe closed injury coagulation dysfunction. Methods Totally 65 patients with severe closed injury who were diagnosed and treated from January 2012 to January 2014 were randomly selected. The bleeding volume was> 2000 ml and the traumatic index was> 17. Serum TNF-α, lipopolysaccharide and coagulation indexes were measured in all patients [ Including PT, APTT and PLT. Linear correlation was used to analyze the correlation of the above indexes. According to the degree of abnormality of coagulation function, two groups were divided into two groups [when PT> (18.00 ± 5.23) s and APTT> (45.00 ± 9.20) s were defined as significant abnormalities in coagulation: 46 patients with coagulation abnormalities and 19 patients with mild coagulation dysfunction. Differences in TNF-α and lipopolysaccharide levels were compared between the two groups. Results Serum levels of TNF-α and lipopolysaccharide were (41.28 ± 8.64) ng / ml and (374.23 ± 121.23) U / L respectively in patients with significant abnormal coagulation function, which were significantly higher than those in mild coagulation dysfunction group [(28.64 ± 5.61) (P <0.01). The results of linear regression analysis showed that there was a positive correlation between lipopolysaccharide and APTT, PT (r = 0.745,0.871, P <0.01) (R = -0.815, P <0.01). TNF-α was positively correlated with APTT and PT (r = 0.894,0.928, P <0.01), and negatively correlated with PLT . In addition, patients with recovered APTT, PT levels were significantly lower than those who died (P <0.01), PLT levels were significantly higher than those of patients with death (P <0.01). Conclusion TNF-α and lipopolysaccharide are closely related to coagulation dysfunction in patients with severe closed injury. Both of them may participate in the occurrence and development of coagulation dysfunction by promoting the heavy consumption of platelets and other coagulation factors. Early detection of TNF-α and lipopolysaccharide Level and give the appropriate treatment will help to improve the patient’s coagulation function.