炎症和凝血指标在脓毒血症诊断和预后评估中价值分析  

Significance of inflammation and coagulation index in diagnosis and prediction of prognosis of sepsis

作　　者：王琼[1] 汤钱球 张小云[1] 嵇金陵 WANG Qiong;TANG Qianqiu;ZHANG Xiaoyun;JI Jinling(The affiliated Huai＇an No.1 People＇s Hospital of Nanjing Medical University,Huai＇an,223300,China)

机构地区：[1]南京医科大学附属淮安第一医院检验科,江苏淮安223300

出　　处：《临床血液学杂志（输血与检验）》2018年第5期750-753,共4页Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)

基　　金：南京医科大学科技发展基金面上项目(No:2016NJMU144)

摘　　要：目的:探讨常见实验室炎症和凝血指标对脓毒血症和非感染性全身炎症反应综合征的鉴别以及对脓毒血症预后的评估价值。方法:回顾性分析2016-01—2017-12入住重症监护病房患者的临床资料,选择脓毒血症患者68例(感染组),非感染性全身炎症反应综合征86例(非感染组)。患者入院24h内检测降钙素原(PCT),白细胞计数(WBC),中性粒细胞计数(NC),血小板(PLT),血小板分布宽度(PDW),平均血小板体积(MPV),凝血酶原(PT)和活化部分凝血活酶时间(APTT),对脓毒血症患者和非感染性全身炎症反应综合征患者进行差异性分析,评价PCT,PLT,PDW,MPV,PT和APTT对脓毒症患者预后的判断价值。结果:感染组患者PCT,MPV,PT和APTT水平(18.79ng/ml、10.95fL、17.1s、49.8s)均高于非感染组(2.09ng/ml,10.25fL,15.6s,42.45s),差异有统计学意义(P<0.05);PLT(125.5×109/L比157×109/L)明显降低,差异有统计学意义(P=0.016)。WBC和NC以及PDW均差异无统计学意义。感染组中死亡者的PDW、PT(16.45fL、18s)均明显高于幸存者(14.1fL、16.5s),差异有统计学意义(P<0.05)。结论:PCT,MPV,PT和APTT的检测可以早期区分脓毒血症和非感染性全身炎症反应综合征,PDW和PT可以反映脓毒血症患者的病情严重程度以及预后情况。Objective：To investigate the value in differential diagnosis between sepsis and noninfectious systemic inflammatory response syndrome with inflammation and coagulation indexes,and to inverstigate the value in assessment of these biomarkers in prognosis in patients with sepsis.Method：Clinical data of patients admitted to intensive care unit of Huai＇an First People＇s Hospital Affiliated to the Nanjing Medical University from January2016 to December 2017 were retrospectively analyzed.A total of 68 patients with sepsis and 86 patient with noninfection SIRS were choosed.Biomarkers were measured within the first 24 hafter admission and data were analyzed between patients with sepsis and noninfection SIRS.The prognosis value of PCT,PLT,PDW,MPV,PT and APTT for sepsis was a secondary outcome.Result：Infection group had higer level of PCT（18.79 vs 2.09,P〈0.001）,MPV（10.95 vs 10.25,P=0.026）,PT（17.1 vs 15.6,P=0.004）and APTT（49.8 vs 42.45,P〈0.001）compared to noninfection group,while PLT counts were significant decreased in infection group（P=0.016）.WBC,NC and PDW had no significant diffience.In infection group,levels of PDW（16.45 vs 14.1,P=0.036）and PT（18 vs 16.5,P=0.024）increased in nonsurvivors than in survivors.Conclusion：A simple bioscore combining PCT together with MPV,PT and APTT improves the early differential diagnosis between sepsis and noninfectious SIRS.PDW and PT could reflect the severity of sepsis and predict the outcomes.

关 键 词：脓毒血症 系统性炎症反应综合征 降钙素原 预后 

分 类 号：R459.7[医药卫生—急诊医学]