脓毒症患者外周血血小板-白细胞聚集体及其分类水平对合并ARDS的预测价值  

The predictive value of Platelets Leukocyte aggregates and its Classification level of Sepsis Peripheral blood on Merge ARDS

作　　者：左蕾[1] 吴永红 拜合提尼沙.吐尔地[1] ZUO Lei;WU Yonghong;BAIHETINISHA·Tuerdi(Department of RICU,First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830054,China;Respiratory Medicine,Jianyang People′s Hospital,Jianyang,Sichuan 641400,China)

机构地区：[1]新疆医科大学第一附属医院RICU,新疆乌鲁木齐830054 [2]简阳市人民医院呼吸内科,四川简阳641400

出　　处：《国际检验医学杂志》2019年第8期955-958,963,共5页International Journal of Laboratory Medicine

基　　金：新疆维吾尔自治区自然科学基金项目(2016D01C255)

摘　　要：目的探究脓毒症患者外周血血小板-白细胞聚集体(PLA)及其分类水平对合并急性呼吸窘迫综合征(ARDS)的预测价值。方法对2015年1月至2018年5月间新疆医科大学第一附属医院收治的150例脓毒症患者进行分析,根据是否出现ARDS分为脓毒症组(非ARDS患者,90例)和ARDS组(发生ARDS患者,60例)。所有患者均行流式细胞术进行PLA检测和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及序贯器官衰竭评估(SOFA)评分,比较两组PLA水平及血小板单核细胞聚集体(PMA)、血小板中性粒细胞聚集体(PNA)、血小板淋巴细胞聚集体(PLyA)水平和APACHEⅡ、SOFA评分的差异,以"ARDS柏林定义"作为"金标准",应用受试者工作曲线(ROC)评价上述指标在预测脓毒症合并ARDS中的效能。结果 ARDS组的PLA和PMA水平以及APACHEⅡ和SOFA评分明显高于脓毒症组(t=4.025、8.328、6.599、7.029,P=0.005、0.000、0.000、0.000),ARDS组和脓毒症组的PNA和PLyA水平间无明显差异(t=1.023、1.267,P=0.308、0.207);ROC曲线显示,PMA预测脓毒症合并ARDS的曲线下面积最高(AUC=0.860,P=0.029),其次为SOFA评分、APACHEⅡ评分和PLA(AUC=0.741、0.723、0.669,P=0.040、0.044、0.046),其中PMA的AUC分别高于PLA(Z=3.469,P=0.001)、APACHEⅡ评分(Z=2.536,P=0.011)和SOFA评分(Z=2.430,P=0.015),PMA的最佳截点为≥13.99%。PMA预测脓毒症患者发生ARDS的灵敏度为86.67%,明显高于PLA、APACHEⅡ评分和SOFA评分,差异均有统计学意义(F=9.257,P=0.004)。结论脓毒症合并ARDS患者具有较高的外周血PLA水平,其中PMA升高更为明显;PMA在早期预测ARDS中有较高的灵敏度,其最佳截点为≥13.99%。Objective The predictive value of Platelets Leukocyte aggregates and its classification level of Sepsis Peripheral blood on Merge ARDS.Methods From January 2015 to May 2018,150 cases of sepsis in the First Affiliated Hospital of Xinjiang Medical University were analyzed.According to the occurrence of ARDS,the patients were divided into sepsis group(non ARDS patients,90 cases)and ARDS group(ARDS patients,60 cases).All patients were treated with flow cytometry for PLA detection and acute physiological and chronic health status score system(APACHEⅡ)score and sequential organ failure assessment(SOFA)score.PLA levels and platelet mononuclear aggregates(PMA),platelet neutrophils aggregates(PNA),platelet lymphocyte aggregation(PLyA)and APACHEⅡ,SOFA scores of the two groups were compared.Using the Berlin definition of ARDS as the gold standard,the ROC was used to evaluate the effectiveness of the above indexes in predicting sepsis complicated with ARDS.Results The levels of PLA and PMA and the scores of APACHEⅡand SOFA in group ARDS were significantly higher than those in sepsis group(t=4.025,8.328,6.599,7.029,P=0.005,0.000,0.000,0.000).There was no significant difference in the levels of PNA and PLyA between ARDS and sepsis group(t=1.023,1.267,P=0.308,0.207).The ROC curve showed that PMA predicted the highest area under the curve(ARDS,AUC=0.860,P=0.029)for sepsis.Followed by SOFA score,APACHEⅡscore and PLA(AUC=0.741,0.723,0.669,P=0.040,0.044,0.046).The AUC of PMA was higher than that of PLA(Z=3.469,P=0.001),APACHEⅡscore(Z=2.536,P=0.011)and SOFA score(Z=2.430,P=0.015),respectively.The best intercepting point of PMA is more than 13.99%.The sensitivity of PMA in predicting ARDS in sepsis patients was 86.67%,which was significantly higher than that of PLA,APACHEⅡand SOFA(F=9.257,P=0.004).Conclusion The patients with sepsis with ARDS have higher peripheral blood PLA levels,and the increase of PMA is more obvious;PMA has high sensitivity in the early prediction of ARDS,and the best intercepting point is more than

关 键 词：脓毒症 急性呼吸窘迫综合征 血小板-白细胞聚集体 预测价值 

分 类 号：R446.11[医药卫生—诊断学]