抗凝血酶Ⅲ、蛋白C水平与脓毒症患者病情严重程度及预后关系的临床研究  

Clinical study on the relationship between antithrombin Ⅲ and protein C levels and the severity and prognosis of sepsis patients

作　　者：董世笑[1] DONG Shixiao(Qilu Hospital of Shandong University,Ji′nan250012,China)

机构地区：[1]山东大学齐鲁医院,山东济南250012

出　　处：《中国现代医生》2020年第32期114-117,共4页China Modern Doctor

基　　金：山东大学齐鲁医学院科研基金(青年项目)(2017 QLQN38)。

摘　　要：目的探讨抗凝血酶Ⅲ(antithrombinⅢ,ATⅢ)、蛋白C(Protein C)水平与脓毒症的病情严重程度及预后的关系。方法选择2010年11月~2017年11月脓毒症患者200例,观察AT-Ⅲ、PC水平及根据脓毒症严重程度分为脓毒症组(S1)共59例,严重脓毒症组(S2)共86例,脓毒症休克组(S3)共55例,比较三组的AT-Ⅲ、PC水平。根据患者28 d预后情况分为存活组与死亡组,比较两组AT-Ⅲ、PC水平。评价AT-Ⅲ、PC对脓毒症患者预后的判断价值。结果(1)S2组、S3组AT-Ⅲ水平低于S1组,两组比较差异有统计学意义(P<0.05);S2组、S3组PC水平低于S1组,两组比较差异有统计学意义(P<0.05);S3组AT-Ⅲ水平显著低于S2组,两组比较,差异有统计学意义(P<0.05);两组PC水平比较,差异无统计学意义(P>0.05)。(2)死亡组患者AT-Ⅲ、PC水平明显低于存活组,差异有统计学意义(P<0.05)。(3)AT-Ⅲ、PC、APACHEⅡ评分预测脓毒症患者死亡的ROC曲线下面积分别为0.5901,0.6098,0.5901。当AT-Ⅲ取42.5%为截断值时,其敏感度为21%,特异度为91.3%;当PC取49.5%为截断值时,其敏感度为40.3%,特异度为81.2%。结论脓毒症患者的AT-Ⅲ、PC水平较低,其与脓毒症的严重程度密切相关,并对其预后具有一定的指导意义。Objective To explore the relationship between antithrombinⅢ(ATⅢ),protein C(PC)levels and the severity of sepsis and its influence on the prognosis.Methods A total of 200 patients with sepsis admitted to our hospital from November 2010 to November 2017 were selected as research objects.According to the levels of AT-Ⅲand PC and the severity of sepsis,they were divided into the sepsis group(n=59,S1),the severe sepsis group(n=86,S2),and the septic shock group(n=55,S3).The levels of AT-Ⅲand PC in three groups were compared.According to the 28-day prognosis,the patients were divided into the survival group and death group,and the levels of AT-Ⅲand PC in the two groups were compared.The prognostic value of AT-Ⅲand PC in patients with sepsis was evaluated.Results(1)The level of AT-III in S2 and S3 groups was lower than that in S1 group,and the difference was statistically significant(P<0.05).The level of PC in S2 and S3 groups was lower than that in S1 group,and the difference was statistically significant(P<0.05).The level of AT-III in S3 group was significantly lower than that in S2 group,and the difference was statistically significant(P<0.05).There was no significant difference in PC level between the two groups(P>0.05).(2)The levels of AT-III and PC in the death group were significantly lower than those in the survival group,and the difference was statistically significant(P<0.05).(3)The areas under the ROC curve of AT-Ⅲ,PC and APACHEⅡscores for predicting the death of septic patients were 0.5901,0.6098 and 0.5901,respectively.When 42.5%was taken as cutoff value,the sensitivity of AT-Ⅲwas 21%and the specificity was 91.3%.When 49.5%was taken as cutoff value,the sensitivity of PC was 40.3%and the specificity was 81.2%.Conclusion The levels of AT-Ⅲand PC are low in patients with sepsis,which are closely related to the severity of sepsis and have certain guiding significance for the prognosis.

关 键 词：脓毒症 抗凝血酶-Ⅲ 蛋白C 预后 

分 类 号：R459.7[医药卫生—急诊医学]