Relationship Study Between DIC And Changes Of Plasm F1+2, D-D, TM Levels In Severe Multiple Injury Patients

Disseminated intravascular coagulation is one of the common complications of severe trauma.By long theoretic study and clinical practice,the knowledge of DIC is known more and more,and all kinds of therapeutic measures have been taken to decrease the DIC mortality.However,DIC mortality is still high clinically,which is not resolved yet.So,to take precaution against DIC early and to take effective measures are very important to prevent the occurrence of DIC.At present,there are lots of studies on single predicting marker of DIC,but the study of predicting DIC occurrence using different markers from multiple aspects is scarcely reported in documents.Through qualitative and quantitative analysis of changes of plasm F1+2,D-D and TM levels in severe multiple injury patients,the author tries to analyse the correlation between DIC and them,thereby to provide theoretic proof and experiment basement for early warning the DIC caused after trauma.ObjectiveThe primary objective of the study is to explore the correlation and its clinical significance between the DIC caused after trauma and the changes of plasm F1+2,D-D and TM levels in severe multiple injury patients.Materials and methodsSixty six multiple-injury patients were divided into minor-injury(ISS＜16) group (21 cases)and severe multiple-injury(ISS≥16) group(45cases).Then severe multiple-injury (ISS≥16) group were devided into DIC group(12cases) and non-DIC group(33 cases).Another 10 healthy people served as the control group.Semi-random control trial was taken.Venous blood was collected once in the control group and in other group venous blood was collected on 1,3 and 7 day after trauma;it was centrifuged at the force of 1500 g for 15 minutes,then immediately stored in a -80℃icebox.The concentration of plasm F1+2 and TM were measured by Sandwich ELISA technique(the ELISA kit were respectively provided by Dade—Berring corporation,America and Diaclone Research,France),the concentration of plasm D-D was measured by Automated latex enhanced immunoassay(the kit was provided by Instrumentation Laboratory corporation,America).Results1.Compared to the control group,the F1+2 level of the minor injury group and the sever multiple injury group both increased at every time point after trauma(P＜0.01);the F1+2 level of the two groups both decreased after trauma,the minor injury group decreased great(P＜0.05)while the sever multiple injury group decreased slowly,and the F1+2 level of the sever multiple injury group was remarkably higher than that of the minor injury group at every time point after trauma(P＜0.05).2.Among severe multiple injury patients,the F1+2 level of the DIC group was remarkably higher than the non-DIC group at every time point after trauma(P＜0.01).In the non DIC group,it gradually decreased,while in the traumatic DIC group,it rose continuously.3.Compared to the control group,the D-D level of the minor-injury group and the sever multiple-injury group both increased at every time point after trauma(P＜0.01);The plasma D-D concentrations of the mionr injury group gradually rose from the 1^st to the 3^rd day,then it decreased great from the 3^rd day to the 7^th day(P＜0.01),while the plasma D-D concentrations of the severe multiple jnjury group gradually rose from the 1^st to the 3^rd day, then it rose great from the 3^rd day to the 7^th day(P＜0.05) and the plasma D-D concentrations of the severe multiple jnjury group were significantly higher than that of the minor injury group at every time point(P＜0.01).4.Among severe multiple injury patients,the D-D level of the DIC group was remarkably higher than the non-DIC group from the 3^rd day to the 7^th day after trauma.In the non DIC group,the D-D level decreased continuously(P＜0.01),while in the traumatic DIC group,it rose great continuously(P＜0.01).5.The TM level of the minor-injury group was remarkably higher than that of the control group at the 1^st day after trauma(P＜0.05),then it decreased slowly from the 1^st to the 3^rd day,great from the 3^rd day to the 7^th day(P＜0.05).From the 3^rd day on,the TM level of the minor-injury group decreased to the normal level.The TM level of the sever multiple-injury group was remarkably higher than that of the control group at every time point(P＜0.01),and the TM level gradually rose from the 1^st to the 3^rd day,then it decreased great from the 3^rd day to the 7^th day(P＜0.01).The TM level of the sever multiple-injury group was remarkably higher than that of the minor-injury group at every time point(P＜0.01).6.Among severe multiple injury patients,the TM level of the non DIC group remarkably decreased(P＜0.01),while in the traumatic DIC group,it rose significantly from the 1^st to the 3^rd day(P＜0.01) and decreased great from the 3^rd to the 7^th day(P＜0.01).the TM level of the DIC group was significantly higher than the non-DIC group at every time point after trauma(P＜0.01).7.Plasm F1+2,D-D and TM levels all had significant positive correlations with DIC occurrence at every time point.Plasm F1+2,D-D and TM levels all had significant positive correlations each other at every time point.ConclusionsAt the acute phase after severe multiple injury,the plasm F1+2,D-D and TM levels all rise significantly.There is significant correlation between DIC caused by trauma and the changes of F1+2,D-D and TM levels.There is significant correlation among the levels of F1+2,D-D and TM.Therefore,at the acute phase after severe trauma,the levels of plasm F1+2,D-D and TM may play an important role in early warning the DIC caused after trauma.