Chinese Medical Sciences Journal ›› 2020, Vol. 35 ›› Issue (2): 151-156.doi: 10.24920/003606

• 论著 • 上一篇    下一篇

注射用血凝酶致低纤维蛋白原血症的临床实验室特征分析:一项回顾性研究

胡静雯,秦晓松()   

  1. 中国医科大学附属盛京医院 检验科,沈阳 110004,中国
  • 收稿日期:2019-05-13 接受日期:2019-11-20 出版日期:2020-06-30 发布日期:2020-06-09
  • 通讯作者: 秦晓松 E-mail:qinxiaosongsy@126.com

Hypofibrinogenemia Caused by Hemocoagulase Injection: A Retrospective Study on Clinical Laboratory Findings

Hu Jingwen,Qin Xiaosong()   

  1. Department of Laboratory Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China
  • Received:2019-05-13 Accepted:2019-11-20 Published:2020-06-30 Online:2020-06-09
  • Contact: Qin Xiaosong E-mail:qinxiaosongsy@126.com

摘要: 目的 注射用白眉蛇毒血凝酶已广泛应用于出血性疾病的治疗。这项研究旨在对血凝酶引起的低纤维蛋白原血症进行临床实验室的特征分析。方法 回顾性分析我院2015年1月1日至2018年3月31日收治的27例因接受注射用血凝酶治疗咯血症状并发展为低纤维蛋白原血症的住院患者。收集的临床资料包括临床表现、凝血及纤溶指标、注射用血凝酶用量、用药时间、冷沉淀血产品输注等。比较血凝酶注射剂治疗前、治疗期间及停药后患者血浆纤维蛋白原、D-二聚体、纤维蛋白/纤维蛋白原降解产物(FDP)的差异,并分析此类差异与血凝酶注射剂剂量及患者低纤维蛋白原血症康复时间的相关性。结果 血凝酶注射期间血浆纤维蛋白原水平与治疗前相比明显降低(F=1.80,P<0.001),平均降低水平为2.28 g/L(0.63 g/L-3.9 g/L)。停药后,纤维蛋白原水平较治疗期间显著升高(F=-1.20,P<0.001),但仍显著低于药物治疗前水平(F=0.59,P<0.05)。停药后D-二聚体水平存显著低于给药期间水平(F=0.83,P<0.01),停药后FDP水平也显著下降(Z=-4.54,P<0.001)。Spearman相关性分析发现,无论是给药前后纤维蛋白原的变化,还是停药后FDP的变化,均与血凝酶的使用剂量(r=-0.17,P=0.40;r=-0.28,P=0.15)无相关性,二者也与低纤维蛋白原血症患者康复时间无显著相关性(r=-0.45,P=0.05;r=0.13,P=0.61)。结果 咯血患者在接受注射用血凝酶治疗时,必须同时监测凝血和纤溶指标。临床医生应当警惕低纤维蛋白原血症的发生,并考虑适时终止使用血凝酶注射剂。

关键词: 低纤维蛋白原血症, 血凝酶, 纤维蛋白原, 纤维蛋白溶解

Abstract: Objective Hemocoagulase injection based on the venom of Agkistrodon halys Pallas is widely used in the treatment of hemorrhagic disorders. This study aimed to characterize the clinical laboratory findings of hemocoagulase-induced hypofibrinogenemia as the associated adverse reaction of hemocoagulase injection.Methods We retrospectively enrolled 27 in-patients who were treated with hemocoagulase injection for hemoptysis and developed hypofibrinogenemia during the period of January 1, 2015 to March 31, 2018. Clinical data were collected and investigated, including clinical manifestations, hemostatic and fibrinolytic parameters, dosage of hemocoagulase, the medication time, and the cryoprecipitate blood product infusion. Differences in fibrinogen, D-dimer, and fibrin/fibrinogen degradation products (FDP) before, during, and after the application of hemocoagulase injection were analyzed statistically.Results Plasma fibrinogen level during medication of hemocoagulase injection decreased significantly compared to that before the treatment (F=1.80, P<0.001), with the average decrease of 2.28 g/L (0.63-3.9 g/L). After withdrawal, fibrinogen level increased significantly compared to that during the medication (F=-1.20, P<0.001), but was still lower than that before the medication (F=0.59, P=0.03). The D-dimer level and the FDP level after withdrawal decreased significantly compared to the levels during the medication (F=0.83, P=0.002; Wilcoxon-test, Z=-4.54, P<0.001). Spearman’s correlation analyses did not find either fibrinogen change during-before the administration or FDP change after-during the administration was associated with the dosage of hemocoagulase (r=-0.17, P=0.40; r=-0.28, P=0.15; respectively) and the time of recovery from hypofibrinogenemia (r=-0.45, P=0.05; r=0.13, P=0.61; respectively).Conclusion Monitoring both clotting and fibrinolysis parameters is essential in the management of hemoptysis patients treated with hemocoagulase injection. Clinicians should be aware of hypofibrinogenemia and consider discontinuation of the administration of hemocoagulase whenever necessary.

Key words: hypofibrinogenemia, hemocoagulase, fibrinogen, fibrinolysis

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