Correlation And Clinical Significance Of Endothelial Cell Damage,inflammatory Factors And Coagulation Indicators For Sepsis In The Patients With Hematological Malignacies

Objective To observe the expression of endothelial cell damage,inflammation markers and coagulation indicators for sepsis in patients with hematological malignancies,and to explore the correlation among them and clinical significance.Methods A prospective controlled study was adopted.1.Case selection: Affiliated Hosptial of Mongolia Medical University From May2015 to December 2015 diagnosed hematological malignancies(except for actue promyelocytic leukemia)in hospitalized patients,according to strict criteria to choose,and got a total of 113 patients.According to the degree of infection,113 patients divided into three groups:sepsis group(39cases)and common infection group(31cases),without infection group(43cases).Uninfected group was the group.All infected patients were diagnosed according to clinical manifestations,biochemical tests,imaging examinations and final etiological examination.2.Sepcimen collection:the venous blood was taken from all enrolled patients,and detected markers of inflammation:Procalctonin(PCT),hypersensitive C-reaction protein(hs-CRP),Interleukin-6(IL-6),neutrophil cell surface molecule CD64 pasitive rate,and the correlation indicators of coagulation: prothrombin time(PT),Activated Partial Thromboplatin Time(APTT),D-Dimer(D-D),Antithrombin-III(AT-III),von Willebrand Factor(vWF).In the experimental group,the blood specimens was taken according to the inclusion criteria in the temperature is greater than 38.3?,and the blood culture,while the blood specimens in the control group at the same period.Sent to detect.Among them,flow cytometry was used to determine CD64.The indexes of mean standard deviation(x ± s)said,using the software SPSS17.0 for data processing.Results 1)Compared with the uninfected group,there was no difference about white blood cell count(WBC)and neutrophil cell count(NEUT)between the common infection group and sepsis group,while red blood cell count(RBC),hemoglobin(Hb)decreased,and there were significant differences(p<0.05).2)Compared with the uninfected group,the positive rates of IL-6,hs-CRP,CD64 and PCT in the common infection group and sepsis group were all increased,and increased significantly in the sepsis group,and there was significant difference(p<0.05).ROC curve analysis showed that the area of PCT,hs-CRP,IL-6,CD64 under the curve of inflammation index were 0.999,0.865,0.949,0.976,the sensitivity and specificity of PCT were 99.20% and98.90%,while the sensitivities of hs-CRP,IL-6 and CD64 were 89.60%,91.10% and 96.60%,and the specificities of CRP,IL-6 and CD64 were 81.20%,92.30% and 95.80%,respectively.3)Compared with uninfected group,APTT,D-D,vWF,and PT were higher in the common infection group and sepsis group,while the activity of AT-III was lower(p<0.05);)4)The level of PCT positively correlated with PT,APTT,negatively correlated with AT-III,and there was significant differences(p<0.05).The lever of CD64 positively correlated with PT,APTT,D-D,negatively correlated with AT-III,and there was significant differences(p<0.05).5)vWF positively correlated with PCT,CD64,D-D,APTT,and there were significant differences(p<0.05),but negatively correlated with AT-III,there was significant differences(p<0.05).Conclusion PCT and CD64 can provide more accurate basis for early diagnosis of infection in patients with malignant hematological diseases.Sepsis patients with vWF expression was significantly increased,biomarkers of endothelial cell injury;inflammation and coagulation disorders interact to promote the occurrence and development of sepsis;vWF is a key of inflammation-coagulation network in sepsis.