未成熟血小板比率与脓毒症严重程度的相关性研究  

Association of the immature platelet fraction with sepsis diagnosis and severity

作　　者：王淼[1] 曹书华[2] 王勇强[2] 王兵[2] 杨蕊 杨俊[1] Wang Miao;Cao Shuhua;Wang Yongqiang;Wang Bing;Yang Jun;Yang Rui(Tianjin University of Traditional Chinese Medicine, Tianjin 300193,China（Wang M, Yang J;Department of Intensive Medicine, Tianjin First Central Hospital, Tianjin Institute of Emergency Medicine, Tianjin 300192, China（Cao SH, Wang YQ, Wang B;Tianjin Medical University, Tianjin 300070, China（Yang R)

机构地区：[1]天津中医药大学,天津300193 [2]天津市第一中心医院重症医学科、天津市急救医学研究所,天津300192 [3]天津医科大学,天津300070

出　　处：《中华急诊医学杂志》2018年第7期790-793,共4页Chinese Journal of Emergency Medicine

基　　金：卫生部国家临床重点专科建设项目（2011-873）;天津市卫生和计划生育委员会重点课题2014KR07

摘　　要：目的 探讨未成熟血小板比例（immature platelet fraction, IPF）与脓毒症严重程度的相关性及对脓毒症休克的诊断价值。方法 将2016 年6 月至2017 年6 月收住天津市某三甲医院ICU 的患者作为研究对象，纳入非脓毒症感染患者10 例，脓毒症患者30 例（其中脓毒症非休 克型患者17 例，脓毒性休克型患者13 例）。从天津某大学选取10 例健康者作为对照组。检测各组的IPF、未成熟网织红细胞比例（immature reticulocyte fraction, IRF），并记录患者的SOFA 评分、APACHE Ⅱ评分及临床各项指标。分析比较各组IPF、IRF 的差异及IPF、IRF 与脓毒症休克的关系。统计学方法采用成组t 检验，χ2 检验，Spearman 相关性分析，诊断准确率用ROC 曲线，以P〈0.05 为差异有统计学意义。结果 脓毒症组的IPF 显著高于感染非脓毒症组（6.25±2.92） vs.（2.49±1.03），P〈0.01；脓毒症休克组的IPF 显著高于脓毒症非休克组（4.71±1.79） vs.（ 8.25±2.94）,P〈0.01 ；SOFA ≥ 8 分的脓毒症患者IPF 明显升高（7.41±3.51） vs.（ 4.5±1.7）, P=0.005 ；IPF 与 SOFA 评分成正相关（r=0.58, P=0.001）；IPF 诊断脓毒症休克的曲线下面积AUC=0.78, P=0.01 ；APACHE Ⅱ评分诊断脓毒症休克的曲线下面积AUC=0.81, P=0.004。结论 IPF 与脓毒症的严重程度有关，对脓毒症休克患者有一定的诊断价值。Objective To explore the relationship between immature platelet fraction（IPF） with severity of sepsis and prognosis in patients with septic shock. Methods A total of 40 patients admitted to intensive care units of Tianjin First Central Hospital from June 2016 to June 2017 were enrolled. Of them,10 patients contracted non-sepsis infected,13 patietns with septic shock, and 17 patients with non-complicated sepsis. Ten healthy subjects were recruited as control groups from Tianjin Medical University.IPF and immature reticulocyte fraction （IRF） were detected, and SOFA and APACHE II scores were calculated, and clinical findings of all groups were recorded. The differences in IPF and IRF between the groups were analyzed. The relationship between the IPF and SOFA score was studied, and the role of IPF in the diagnosis of septic shock was evaluated. Statistical methods include t test, MannWhitney test, Spearman correlation analysis, and ROC procedure,and P〈0.05 was considered significant. Results Significantly higher IPF level was observed in patients with sepsis than that in patients with nonsepsis infection.（6.25 ± 2.92） vs. （2.49 ± 1.03）, P〈0.01. Significantly higher IPF level was observed in patients with septic shock than that in patients with non-complicated sepsis（4.71 ±1.79） vs. （8.25 ± 2.94）, P〈0.01. IPF correlated with sepsis severity scores （7.41 ±3.51） vs. （4.5±1.7）, P=0.005; r=0.58, P=0.001.This study presented the highest diagnostic accuracy for the presence of sepsis by all studied clinical and laboratory parameters （AUC=0.78, P=0.01）. Conclusion IPF levels could be used as a biomarker for diagnosis and severity of sepsis.

关 键 词：未成熟血小板比例 脓毒症 脓毒症休克 APACHEⅡ评分 SOFA评分 

分 类 号：R459.7[医药卫生—急诊医学]