凝血及纤溶指标与急性百草枯中毒预后的相关性研究  

The research of the correlations about coagulation dysfunction and fibrinolytic index with the prognosis of acute paraquat intoxication

作　　者：梁栋[1] 赵扬[1] 聂时南[1] 刘红梅[1] 邵旦兵[1] 任艺[1] 张炜[1] 孙兆瑞[1] 杨志洲[1] 唐文杰[1] 

机构地区：[1]南京大学医学院附属金陵医院(南京军区南京总医院)急救医学科,南京210002

出　　处：《临床急诊杂志》2015年第1期1-4,8,共5页Journal of Clinical Emergency

基　　金：南京军区重点课题(NO:12Z32);南京军区南京总医院青年基金课题(NO:2014004)

摘　　要：目的：对百草枯中毒患者凝血功能（血浆凝血酶原时间,活化部分凝血活酶时间,凝血酶时间,抗凝血酶-Ⅲ）及纤溶相关指标（D-二聚体,血浆纤维蛋白原水平、纤溶酶原激活物和纤溶酶原激活物抑制剂-1）与预后的相关研究。方法：回顾性研究2009-03-2014-02的百草枯中毒患者101例,按照生存组和死亡组分为二组比较凝血及纤溶功能与患者预后的关系,并纳入健康对照组进行比较相互间的差异,分析和预后的相关性。结果：急性百草枯中毒组血浆凝血酶原时间,活化部分凝血活酶时间,凝血酶时间,以及抗凝血酶-Ⅲ均低于健康对照组（P〈0.05）,而D-二聚体,血浆纤维蛋白原水平,纤溶酶原激活物和纤溶酶原激活物抑制剂-1高于健康对照组（P〈0.05）。百草枯中毒死亡组D-二聚体,纤溶酶原激活物和纤溶酶原激活物抑制剂-1高于生存组（P〈0.01）,抗凝血酶-Ⅲ低于生存组（P〈0.05）。D-二聚体,纤溶酶原激活物和纤溶酶原激活物抑制剂-1与死亡呈正相关（r值分别为0.658、0.741和0.629,均P〈0.01）,抗凝血酶-Ⅲ水平与死亡呈显著负相关（r=-0.644,P〈0.05）。ROC曲线下面积提示D-二聚体,抗凝血酶,纤溶酶原激活物和纤溶酶原激活物抑制剂-1均具有中高度的预测预后价值,根据最佳截断值D-二聚体,抗凝血酶-Ⅲ,纤溶酶原激活物和纤溶酶原激活物抑制剂-1预测死亡率的灵敏度、特异度、Youden指数分别为69.5%~85.1%,60.5%~89.4%,0.593~0.653。结论：D-二聚体,抗凝血酶-Ⅲ,纤溶酶原激活物和纤溶酶原激活物抑制剂-1对于百草枯中毒预后有较好预测能力。Objective： To determine the correlation of the coagulation function and fibrinolytic index with the prognosis of patients after acute paraquat intoxication. Method： Retrospective study of 101 acute paraquat intoxica- tion patients from 2009-03 to 2014-02 who were divided into surviving group （n=69） and non-surviving group （n =32） ,and compared with the control healthy group （n=40）. The correlation of coagulation function （PT,APTT, TT, AT-Ⅲ ） and fibrinolytic index（D-D, FIB, t PA, PAI-1） on andthe prognosis of patients after acute paraquat intoxication were analyzed. Result：All the patients after acute paraquat intoxication had the disturbance of blood coagulation fibrinolysis compared with control healthy group,the level of PT,APTT,TT and AT-Ⅲ were lower than that in control healthy group （P〈0. 05）. The level of D-D, FIB, t-PA, PAI-1 were higher than control healthy group （P〈0.05）. Non-surviving group after acute paraquat intoxication had higher levels of D-D, t-PA, PAl 1 （P 〈0.01） but lower level of AT-Ⅲ （P〈0.05） than surviving group. The level of D-D,FIB,t-PA,PAI- 1 were posi- tive correlated with death rate for patients after acute paraquat intoxication （r= 0. 658,0. 741,0. 629, respectively,P〈〉0.01）. The level of AT-Ⅲ is negative correlated with death rate （r=-0. 644,P〈0.05）. The area under ROC curve indicated the level of D-D,t-PA,PAI-1 ,AT-Ⅲhave great value on the prognosis of patients after acute pa-raquat intoxication. Based on the best cutoff value, The sensitivity, specificity and Youden index for D-D, AT-Ⅲ , t- PA,PAI-1 on the prognosis of death rate after acute paraquat intoxication were 69. 5%- 85. 1%, 60. 5%- 89. 4 %,0.5 93 - 0.65 3, separetely. Conclusion： D-D, AT- Ⅲ, t-PA, PAI-1 have great value on the prognosis of patients after acute paraquat intoxication.

关 键 词：抗凝血酶-Ⅲ D-二聚体 纤溶酶原激活物 纤溶酶原激活物抑制剂-1 百草枯 预后 中毒 

分 类 号：R595[医药卫生—内科学]