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目的探讨血小板颗粒膜糖蛋白140(CD62P)和血栓前体蛋白(TpP)对严重脓毒症高凝状态的早期诊断价值。方法选取2007年4月~2008年3月本院急诊监护病房(EICU)收治的严重脓毒症的患者入选严重脓毒症组(Ⅲ组),存在感染但未发生脓毒症同期患者设为一般感染组(Ⅱ组),同期门诊体检者或健康自愿者设为正常对照组(Ⅰ组),病例的选取均遵循随机的原则,3组的年龄、性别具有可比性;3组均在入院第1天清晨空腹取外周静脉血测定CD62P、TpP、PT、APTT、Fib、TT、D-D聚体。结果入院第1天,PT、TT在3组中的表达均无显著意义,APTT在严重脓毒症组和一般感染组间的差异无统计学意义,Fib、D-D、CD62P和TpP在严重脓毒症组中的表达均较一般感染组和正常对照组明显升高(P<0.05),且在一般感染组和正常对照组中无明显差异(P>0.05);早期诊断高凝状态的敏感指标依次为CD62P、TpP、Fib、D-D、APTT、PT、TT,而特异指标依次为TpP、CD62P、Fib、APTT、D-D、TT、PT;相关性分析显示:CD62P、与TpP呈明显正相关(r=0.931,P<0.001)。结论严重脓毒症的早期就存在血小板活化和微血栓形成,2者共同参与了早期的高凝状态;CD62P和TpP均能较常规凝血指标更具早期诊断价值,联合试验有助于提高诊断效率。
Objective To investigate the early diagnostic value of platelet granulocyte membrane glycoprotein 140 (CD62P) and thrombus precursor protein (TpP) in severe sepsis hypercoagulable state. Methods Patients with severe sepsis admitted to our hospital emergency department (EICU) from April 2007 to March 2008 were enrolled in severe sepsis group (group Ⅲ) with infection but without sepsis The patients in the general infection group (group Ⅱ), the outpatients in the same period or the healthy volunteers were set as the normal control group (group Ⅰ). The selection of the patients followed the principle of randomness. The age and sex of the three groups were comparable. On the first day of the morning, peripheral blood samples were taken for determination of CD62P, TpP, PT, APTT, Fib, TT and DD aggregates. Results There was no significant difference in the expression of PT and TT in the three groups on the first day after admission. There was no significant difference in the APTT between the severe sepsis group and the general infection group. The levels of Fib, DD, CD62P and TpP in severe sepsis (P <0.05), and there was no significant difference between general infection group and normal control group (P> 0.05). The sensitivity of early diagnosis of hypercoagulable state Followed by CD62P, TpP, Fib, DD, APTT, PT and TT, and the specific indexes were TpP, CD62P, Fib, APTT, DD, TT and PT in turn.Correlation analysis showed that CD62P was positively correlated with TpP = 0.931, P <0.001). Conclusion Serum platelet activation and microthrombosis exist in the early stage of severe sepsis, both of which participate in the early hypercoagulable state. Both CD62P and TpP can be more early diagnostic value than the conventional coagulation index, and the combination test can help to improve the diagnostic efficiency .