Changes of blood coagulation and fibrinolysis functions and plasma thrombomodulin levels in patients with hemorrhagic fever with renal syndrome / 中华传染病杂志

ABSTRACT

Objective To investigate the changes of plasma thrombomodulin (TM),tissue factor (TF),tissue factor pathway inhibitor (TFPI),P-selectin (P sel),von Willebrand factor (vWF) and D-dimer (D-D) levels in patients with hemorrhagic fever with renal syndrome (HFRS) and its clinical significance.Methods Twenty-three cases of HFRS were divided into two groups according to the severity of disease (12 cases in mild group and 11 cases in severe group),and 20 healthy individuals served as control group.Blood samples were collected at every stage of the disease.Plasma TM,TF,TFPI,P-sel and vWF were measured by enzyme-linked immunosorbent assay (ELISA); plasma D-D was detected by nanoparticles enhanced turbidimetric immunoassay; creatine kinase MB isoenzyme (CKMB) was tested by immunosuppression assay; blood clotting time was recorded for blood coagulation functions; blood urea nitrogen (BUN),creatinine (Cr),alanine aminotransferase (ALT),aspartate aminotransferase (AST),and platelets (PLT) were also routinely tested.The comparison between groups was done by analysis of variance and two sided t test.Results During the acute phase of HFRS,the plasma levels of TM,TF,P-sel,vWF and D-D were significantly increased,activated partial thromboplastin time (APTT) was prolonged,international normalized ratio (INR) was elevated,while fibrinogen (Fn) and PLT were decreased markedly as compared to control group.In febrile phase,there were significant differences between severe group and mild group in plasma TM [(1.78±1.00) μmol/L vs (1.33±0.35) μmol/L,t=2.600,P＜0.01],TF [(36.63±8.48) ng/L vs (32.93±10.61) ng/L,t=3.423,P＜0.01],vWF [(327.1±57.2) μg/L vs (260.3±63.2) μg/L,t=2.257,P＜0.01],APTT [(63.9±20.5) s vs (48.7±18.6) s,t=4.920,P＜0.01],and INRlevels(1.8±0.6 vs 1.5±0.4,t=2.276 P＜0.05).The variation curves of TM,P sel,APTT,INR and D-D were similar to those of BUN and ALT,but contrary to PLT count.Conclusions There are significantly elevated plasma levels of TM,vWF,P sel and D-D,prolonged APTT,increased INR,and much decreased plasma Fn and PLT in the acute phase of HFRS,suggesting the presence of extensive capillary injuries and activation of platelet and coagulation system,which is closely associated with kidney,liver and cardiac muscle damage.Hence,it is essential to use antiviral agents,anticoagulants and fluid resuscitation in the early stage of the disease.