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Objective To explore the clinical effect of Salvianolate for treatment of coagulant function abnormality in patients with septic shock.Methods One hundred and fifty-two septic shock patients admitted to Intensive Care Unit (ICU) of Department of Critical Care Medicine,Liuzhou Municipal Liutie Central Hospital from January 2007 to June 2016 were enrolled,and they were divided into a control group (67 cases) and a Salvianolate group (85 cases) by random number table.In the control group,conventional western medicine treatment was given,while in Salvianolate group,besides conventional treatment,additionally,Salvianolate 200 mg intravenous drip was applied daily for consecutive 10 days.The levels of D-dimer and platelet count (PLT) were examined on the 1st,3rd,7th,10th day after admission;disseminated intravascular coagulation (DIC) incidence and mortality were observed in 10 days after admission in the two groups.Results The levels of D-dimer were significantly lower in the Salvianolate group than those of the control group on 3,7,10 days after admission (mg/L:3 days was 9.14 ± 2.25 vs.18.42 ± 3.15,7 days was 6.71 ± 1.49 vs.14.57 ± 1.81,10 days was 1.01-± 0.20 vs.4.79-± 0.81,all P ＜ 0.01).In both groups,on the first day after admission the level of PLT began to decrease,on the 3th,7th day the levels were lowered significantly,and on the 10th day,the level of PLT was elevated;in the Salvianolate group,the levels of PLT were obviously higher on the 3rd,7th,10th day after admission than those of the control group [PLT (x 109/L) 3 days after admission:67.05-± 7.76 vs.40.97 ± 6.51,7 days:67.24 ± 6.35 vs.32.06 ± 5.13,10 days:90.18 ± 11.42 vs.59.04 ± 6.57,all P ＜0.01].The DIC incidence and mortality were significantly lower in the Salvianolate group than those of the control group [DIC incidence:12.94％ (11/85) vs.38.8％ (26/67),mortality:5.88％ (5/85) vs.29.85％ (20/67),both P ＜0.01].Conclusions Coagulant function abnormality was found in most patients with septic shock.The cause of PLT decreasing is mainly due to micro-vascular thrombosis that consumes a lot of PLT.Early intervention with Salvianolate in such patients can inhibit thrombosis,block the exhaustion of PLT and correct the coagulant function abnormality with certain efficacy in the patients.
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Objective To investigate the clinical manifestations and inlfuencing factors in the newborns with coagulant function abnormality in the ifrst 24 hours after birth. Methods The coagulation test results and clinical data of 169 newborns in our hospital were studied. Children receiving anticoagulant therapy were assigned as coagulation abnormalities group (n=76) and other healthy newborns were assigned as control group (n=93). The differences of coagulation function between the two groups were analyzed and the inlfuencing factors of coagulation abnormalities were explored. Results The proportions of fetal distress, pneumonia, acidosis and hypothermia of coagulation abnormalities group were signiifcantly higher than that of the control group (χ2=6.18–38.01, P<0.05). Logistic regression analysis showed that fetal distress (OR=12.06, 95%CI:3.71–39.25), pneumonia (OR=4.10, 95%CI: 1.43–11.74) were the high risk factors for coagulant function abnormality, and the differences were statistically signiifcant (both P<0.05). Conclusions Fetal distress, pneumonia were the high risk factors for coagulant function abnormality. Early prevention can help to reduce the incidence of neonatal hemorrhagic disease.
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BACKGROUND: This study aimed to determine the plasma levels of urokinase-type plasminogen activator (uPA), urokinase-type plasminogen activator receptor (uPAR), D-dimer, IL-6 and TNF-α, and observe the relations among uPA, uPAR, D-dimer, IL-6 and TNF-α in patients with systemic inflammatory response syndrome (SIRS). METHODS: A prospective, clinical case-control study was conducted in patients with SIRS at age of more than 55 years old treated during 2008-2010 at Wuhan Central Hospital. Venous blood samples were collected by routine venipuncture. Eighty-five patients were divided into two groups according to diagnostic criteria of SIRS: SIRS patients from intensive care units (n=50), and non-SIRS patients from medical wards (n=35). Thirty healthy blood donors who visited the General Health Check-up Division at Wuhan Central Hospital served as controls. Excluded from the study were (1) those patients with pregnancy; (2) those with cancer; (3) those died after admission into the ICU in 7 days; (4) those received cardiopulmonary resuscitation; (5) those who had previous blood system diseases; and (6) those with SIRS before admission into the ICU. The levels of uPA, uPAR, D-D, IL-6 and TNF-α in blood were detected by commercial enzyme-linked immunosorbent assay (ELISA) kit. The data were analyzed using SPSS version 17.0 and expressed as mean ± standard. Student's t test and the Mann-Whitney U test were used in the analysis. The relations of uPA, uPAR and D-dimer, IL-6 TNF-α levels were analyzed using Spearman's rank-order correlation coefficient test. RESULTS: The plasma levels of uPA , uPAR, D-dimer,IL-6 and TNF-α in the patients with SIRS were obviously higher than those in the non-SIRS patients and controls (P<0.001). Correlation analysis showed a positive correlation between uPAR and IL-6 levels (r=0.395, P=0.004) and between uPAR and TNF-α levels (r=0.606, P<0.001), but no correlation between uPAR and D-dimer levels (r=0.069, P=0.632). No correlation was observed between uPA, D-dimer, IL-6 and TNF-α levels (P>0.05). The establishment of ROC curve was based on the levels of uPAR, D-dimer, IL-6 and TNF-αin 24 hours for the diagnosis of multiple organ dysfunction syndrome (MODS), and the ROC areas under the curve were 0.76, 0.58, 0.86 and 0.83, respectively. CONCLUSIONS: uPA and uPAR play a major role in patients with SIRS in the process of coagulation disorder, but the mechanism of SIRS is not the same. uPAR may play a central role in the development of SIRS to MODS.
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Objective To test plasma levels of uPA,uPAR,D-dimer,IL-6 and TNF-α,and observe the relationships between uPA,uPAR and D-dimer,IL-6,TNF-αin patients with SIRS.Methods A prospective,clinical case-control study was adopted.Cases were collected from our hospital in January 2008 to January 2010,and all were ＞ 55 years of age.Venous blood samples were collected via routine venipuncture.Eighty-five patients were divided into two groups according to diagnostic criteria of SIRS:SIRS group collected from Intensive Care Unit ( n =50) and non SIRS group collected from medical ward ( n =35).The control group comprised 30 unrelated healthy blood donors who visited the General Health Checkup Division at our hospital.Patients with (1) pregnant women; (2) cancer; (3) died after admitted into ICU in 7 days; (4) after cardiopulmonary resuscitation ; ( 5 ) with previous blood system diseases; (6) patients with SIRS before admitted into ICU were excluded from the study.uPA,uPAR,D-D,IL-6 and TNF-α in blood were detected by commercial enzyme-linked immunosorbent assay (ELISA) kits.The data was analyzed using SPSS version17.0.Data accorded with normal distribution of measurement was expressed as mean ± standard,and analyzed by independent-samples t test; non-normal distribution of measurement data,expressed by median,was analyzed with Mann-Whitney test.Relationships between plasma levels of uPA,uPAR and D-dimer,IL-6 TNF-α were analyzed using Spearman rank correlation test.To compare with blood level of uPA,uPAR,IL-6 and TNF-α in SIRS patients in the application of diagnostic value of MODS,we constructed the receiver operating characteristic curve ( ROC curve) for blood levels of uPA,uPAR,IL-6 and TNF-α in 24 h.Results The plasma levels of uPA,uPAR,D-dimer,IL-6 and TNF-αin patients of SIRS were obviously higher compared with non-SIRS and normal controls ( all P ＜ 0.01 ).Correlation analysis showed that there was positive correlation between uPAR level and IL-6 level (r =0.395,P =0.004) ; there was positive correlation between uPAR level and TNF-αlevel ( r =0.606,P ＜0.01 ).There was no correlation between uPAR levd and D-dimer level ( r =- 0.069,P =0.632).There was no correlation between uPA level and D-dimer,IL-6 or TNF-α ( all p ＞ 0.05).There ROC curve were made based on the abilities of uPAR,D-dimer,IL-6 and TNF-αlevels in 24 hours to diagnose MODS,and the ROC areas under the curves were 0.76,0.58,0.86,0.83 respectively.Conclusions These results demonstrate that uPA and uPAR play a major contributory role in patients with SIRS in the process of coagulation disorders,but the mechanism in SIRS is not the same.uPAR may play a central rolein the development of SIRS to MODS.