Variations Of TF, ATⅢ, PAI-1 And APC% Levels In The Blood Of Patients With Severe Multiple-Trauma And Their Function To Prevent The Occurrence Of Pre-DIC

BackgroundDisseminated Intravascular Coagulation (DIC) is one of the common complications of severe trauma, which, if not diagnosed and treated in time, may endanger the lives of patients. Through long-term theoretical research and clinical practice, DIC is known more and deeper, and a variety of therapeutic measures have been attempted to reduce the mortality rate of patients with DIC, which, however, clinically remains high and unsolved. The prophase of DIC is called Pre-DIC. So, to spot Pre-DIC indicators and take effective precautions is of great significance to prevent or reduce the occurrence of DIC. This study makes both a qualitative and a quantitative analysis of variations of TF, ATIII, PAI-1 and APC% in blood of patients with severe trauma, and their correlation with Pre-DIC as well, thereby providing theoretical proof and experimental basis for DIC predicting after trauma.Materials and MethodsForty-four multiple-trauma patients were divided into minor-injury(ISS<16) group(15 cases) and severe multiple-trauma(ISS≥16)group(29cases). Then severe-trauma(ISS≥16) group was divided into Pre-DIC group(16 cases)and non-Pre-DIC group(28 cases). Another 10 healthy people served as the control group. Semi-random control trial was taken. Venous blood was collected on day 1, 3 and 6 in the control group and in other group venous blood was collected on day 1, 3 and 6 after trauma; it was centrifuged at the force of 2500g for 15 minutes, then immediately stored in a -80℃icebox. The concentrations of plasma TF and PAI-1 were measured by using Sandwich ELISA technique, while the concentrations of ATIII and PC were determined by using Chromogenic Peptide Substrate Method, and Italy-made ACL-Aclance automatic analyzer. Results1. Compared to the TF level of the control group, both the TF level of the minor-injury group and that of the sever multiple-trauma group increased significantly, and were significantly higher at each time point after trauma(P<0.01), the increase being very obvious from the 1st day to the 3rd day, and slowing down from the 3rd day to the 6th day. The TF level of the sever multiple-trauma group was remarkably higher than that of the minor-injury group at each time point after trauma(P<0.05). The increase in TF levels of both the Pre-DIC group and non-Pre-DIC group was remarkable from the 1st day to the 3rd day(P<0.01), but slowed down from the 3rd day to the 6th day. The TF level of the Pre-DIC group higher than that of the non-Pre-DIC group at each time point after trauma(P<0.01).2. Compared to the ATIII level of the control group, the ATIII levels of the minor-injury group and the sever multiple-trauma group both decreased at each time point after trauma(P<0.01). The plasma ATIII of the sever multiple-trauma group was slightly lower than that of the minor-injury group on the 1st day, but significantly lower than the latter from the 3rd day to the 6th day(P<0.05). Both the ATIII levels of the Pre-DIC group and the non-Pre-DIC group decreased continuously(P<0.05). Among patients with severe multiple-trauma, the ATIII level of the Pre-DIC group was remarkably lower than that of the non-Pre-DIC group at each time point after trauma.3. Both the APC% levels of the minor-injury group and the sever multiple-trauma group were remarkably higher than that of the control group at each time point after trauma(P<0.01). The APC% level of the sever multiple-trauma group was remarkably higher than that of the minor-injury group at each time point(P<0.05). Among patients with severe multiple-trauma, the APC% levels of the Pre-DIC group and the non-Pre-DIC group both increased remarkably at each time point after trauma.4. On the first day, the PAI-1 levels of the minor-injury group and the sever multiple-trauma group were remarkably higher than that of the control group, the PAI-1 level of the sever multiple-trauma group being remarkably higher than that of the minor-trauma group. Both the PAI-1 levels of the minor-injury group and the sever multiple-trauma group decreased significantly from the 3rd day to the 6th day(P<0.05), and the PAI-1levels approach the control group.5.Plasma TF and APC% levels both had significantly positive correlation with Pre-DIC occurrence at each time point. Plasma ATIII level had clearly negative correlation with Pre-DIC occurrence at each time point. The change of PAI-1 level had no correlation with Pre-DIC occurrence.Conclusion1. Trauma patients'plasma TF level increases progressively after trauma, the TF level of the Pre-DIC group is higher than that of the non-Pre-DIC group, and its change is positively related with the occurrence of Pre-DIC, indicating that the determination of acute phase change in TF levels may be of some clinical value in the prediction of the occurrence of post-traumatic Pre-DIC.2. The ATIII levels of the minor-injury group and the sever multiple-trauma group both decrease after trauma, the plasma ATIII concentration of the severe multiple-trauma group is significantly lower than that of the minor-injury group at each time point after trauma, the ATIII level of the Pre-DIC group is remarkably lower than that of the non-Pre-DIC group, and the ATIII level is negative related to the occurrence of post-traumatic Pre-DIC, indicating that the continuous decrease of the ATIII level is of some clinical value in predicting Pre-DIC.3. Trauma patients'serum APC% level increases remarkably after trauma, that of the sever multiple-trauma group being remarkably higher than that of the minor-injury group, the APC% levels of the Pre-DIC and the non-Pre-DIC group both increase remarkably, that of the Pre-DIC group being higher than that of the non-Pre-DIC group, and its change is positively related with the occurrence of Pre-DIC, indicating that detecting the change of APC% level is of some clinical value in prediction Pre-DIC.