The Study Of Changes Of Coagulation And Fibrinolysis Function On Acute Stage Of Community-Acquired Pneumonia

Objective To explore the changes of coagulation and fibrinolytic system in patients of community-acquired pneumonia(CAP),the influence of CAP on blood gas analysis and hepatic function, and the influence of liver functional impairment on coagulation and fibrinolytic system.Methods A prospective case-control study was performed in 37 patients with CAP, before-after study in the same patients, and with the normals. Collecting vein blood and arterial blood of CAP patients immediately and 7 days later separately after patients admission to the hospital. The vein blood was to exam blood routine,4 test items of blood coagulation, D-Dimer, Antithrombin-III,liver function, kidney function, C-Reactive Protein, and the arterial blood was to exam blood gas analysis. Put vein blood 1.8ml into the test tube which was installed 3.2% citrate 0.2ml in advance. After enough immingle, centrifugalize 10 minutes,3000rpm,4t.Then the supernatant was taken and placed in the EP tube and stored at -70℃freezer for further investigation. The amount of PAI-l,t-PA,and TFPI in the supernatant were detected by ELISA. Thirty healthy subjects were included as controls. Collect vein blood and arterial blood of controls. The vein blood was to exam blood routine,4 test items of blood coagulation, D-Dimer, Antithrombin-Ⅲ,liver function, kidney function, C-Reactive Protein, and the arterial blood was to exam blood gas analysis. Put vein blood 1.8ml into the test tube which was installed 3.2% citrate 0.2ml in advance. After enough immingle, centrifugalize 10 minutes,3000rpm,4t.Then the supernatant was taken and placed in the EP tube and stored at -70℃freezer for further investigation. The amount of PAI-1,t-PA,and TFPI in the supernatant were detected by ELISA. This prospective study was performed to explore the changes of coagulation and fibrinolytic system in patients of community-acquired pneumonia (CAP), the influence of CAP on blood gas analysis and hepatic function, and the influence of liver functional impairment on coagulation and fibrinolytic system.Results First, between the CAP patients and normal controls, there were no statistical differences for age and gender. Second, after therapy for 1 week, the inflammatory indicators as White Blood Cell, Granulocyte and C-Reactive Protein(CRP) descend, but only the descent of CRP have statistical difference (P< 0.01).Third, when the CAP patients compare with the normal controls, the Thrombin Time(TT) shorter (P < 0.01), Fibrinogen(FIB) and D-Dimer(DD) higher (P< 0.01), Antithrombin-III(AT-III) lower (P< 0.01), Tissue Factor Pathway Inhibitor(TFPI) higher (P>0.05), Plaminogen Activator Inhibitor type 1(PAI-1) higher (P<0.01), Tissue-type Plaminogen Activator(t-PA) lower (P< 0.01).After therapy for 1 week, all of the above to recover, but the FIB is still higher (P<0.01), the AT-III and t-PA are sill lower than the normal group (P<0.01).Fourth, the acute stage of CAP have hypohepatia,the Alanine aminotransferase(ALT),Aspartate aminotransferase (AST) and Gamma-Glutamyl Transferase (γ-GT) of CAP patients are higher than the normal controls (P< 0.05), and the Total Protein(TP) and Albumin(ALB) are lower (P< 0.05). Fifth, the pressure of O2 (PaO2), arterial oxygen saturation (SaO2) of CAP patients are lower, and the lactic acid is higher than the normal controls. Sixth, the hypohepatia of CAP patients don't influence the coagulation, anticoagulation and fibrinolysis function. Between the CAP patients of normal liver function and hypohepatia, there were no statistical difference for PT,APTT,TT,FIB,AT-III,TFPI,PAI-1 and t-PA (P> 0.05)Conclusion In the acute stage of CAP, coagulation activation, anticoagulant substances reduction, inhibition of fibrinolysis, lead to a procoagulant state resulting in fibrin deposition in the interstitial of lung. The injury of Gas exchange function leads the PaO2 to decrease. The hypohepatia of CAP patients don't influence the coagulation, anticoagulation and fibrinolysis function. After therapy for 1 week, the inflammatory indicators of CAP patients decrease, the index of coagulation, anticoagulation and fibrinolysis recover partially.