感染症と治療ジャーナル

抽象的な

Hemostasis in Erysipelas-The Reason for Considering Antithrombotic Therapy

Fokina EG

The indices of external (prothrombin time, INR) and internal (activated partial prothrombin time (aTpp) coagulation pathways, the degree of disfibrinogenemia (thrombin time, functional fibrinogen activity and D-dimer level), the amount and functional activity of the platelets (aggregation with ADP) and the erythrocytes (aggregation with lanthanoid and protamine sulfate) were studied in 60 patients with erysipelas. Also, we have studied endothelial dysfunction manifested in the decrease of athrombogenicity of vascular wall endothelium (antithrombin III and protein C) and in the increase of adhesive properties of the endothelium (von Willebrand factor).

The comparison groups comprised normal volunteers (n=32) and patients with focus of inflammation localized on the face (n=24), and the legs (n=36) at various stages of the disease (day 1–3; 4-6; 7-10; and 11-15 from the onset of the disease), undergoing in hospital treatment in Moscow 2nd Clinical Hospital for the Infectious Diseases.

The thesis, according to which the rate of hemorrhagic complications in leg erysipelas is by 3,9 times higher than in facial erysipelas, was confirmed by laboratory findings. In particular, a significant decrease of protein C was noted in patients with leg erysipelas and concomitant chronic venous insufficiency. We have found increased D-dimer and decreased α2-macroglobulin levels, suggesting potent activation of proteolytic enzymes (plasmin, matrix metalloproteinases, neutrophil elastase), which can be one of the causes of bullae, erosion and ulceration formation in the erysipelas focus on the lower limb.

The signs of intravascular (latent) hemolysis - the decrease of haptoglobin concentration and the increase of indirect bilirubin and LDH blood level; the changes of rheological properties of erythrocytes – the increase of deformability (aggregation with lanthanum chloride) and the decrease of elasticity (aggregation with protamine sulfate) – have been identified as one of the main factors for DIC-like syndrome in erysipelas.