D-二聚体对新型冠状病毒肺炎患者危重程度及预后的评估价值  

Evaluation value of D-dimer in severity and prognosis of patients with novel coronavirus pneumonia

作　　者：张利娟[1] 谢丹[1] 陈海华[1] 赵剡[1] 夏剑[1] ZHANG Lijuan;XIE Dan;CHEN Haihua;ZHAO Yan;XIA Jian(Emergency Center,Zhongnan Hospital of Wuhan University /Hubei First Aid and Resuscitation Clinical Medical Research Center,Wuhan,Hubei 430071,China)

机构地区：[1]武汉大学中南医院急救中心/湖北省急救与复苏临床医学研究中心,430071

出　　处：《重庆医学》2021年第1期118-121,共4页Chongqing medicine

摘　　要：目的探讨新型冠状病毒肺炎(COVID-19)患者血浆D-二聚体水平与患者危重程度及预后的相关性。方法回顾性分析2020年1月5日至2月15日该院隔离病房经核酸检测确诊的105例COVID-19患者资料。根据患者的急性生理和慢性健康评分(APACHE-Ⅱ)分值分为非重型组(n=22)、重型组(n=37)和危重型组(n=46),比较3组患者的血浆D-二聚体水平及病死率。根据预后将患者分为存活组(n=88)和死亡组(n=17),比较两组患者的APACHE-Ⅱ分值、血浆D-二聚体水平。分析血浆D-二聚体水平与APACHE-Ⅱ分值的相关性,并利用受试者工作曲线(ROC)分析血浆D-二聚体水平与预后之间的关系。结果危重型组患者血浆D-二聚体水平明显高于重型组[(1785±420)ng/mL vs.(628±127)ng/mL,P<0.01],且重型组高于非重型组[(628±127)ng/mL vs.(277±87)ng/mL,P<0.01]。危重型组、重型组和非重型组各有14、3、0例患者死亡。死亡组患者的血浆D-二聚体水平明显高于存活组[(1257±364)ng/mL vs.(461±384)ng/mL,P<0.01],APACHE-Ⅱ分值也明显高于存活组(17.7±4.6 vs.8.3±3.5,P<0.05)。Pearson相关分析提示死亡患者的血浆D-二聚体水平与APACHE-Ⅱ分值呈正相关(r=0.647,P<0.01)。ROC分析结果表明血浆D-二聚体水平在1498 ng/mL阈值时,预测患者死亡的ROC曲线下面积为0.91,灵敏度为75%,特异度为93%。结论COVID-19患者血浆D-二聚体水平与患者APACHE-Ⅱ分值呈正相关,对预测患者危重症程度及预后有一定评估价值。Objective To investigate the correlation between plasma D-dimer level and the severity and prognosis of patients with novel coronavirus pneumonia.Methods Data of 105 novel coronavirus pneumonia patients diagnosed by nucleic acid in the isolation ward from January 5,2020 to February 15 were retrospectively collected.According to the APACHE-Ⅱscore,the patients were divided into the non-severe group(n=22),the severe group(n=37)and the critical group(n=46),and the plasma D-dimer level and mortality rate of the 3 groups were compared.The patients were divided into the survival group(n=88)and the death group(n=17)according to the prognosis of the patients,and the APACHE-Ⅱscore and plasma D-dimer level of the two groups were compared.Correlation between plasma D-dimer level and APACHE-Ⅱscore was was analyzed,and the relationship between plasma D-dimer level and prognosis was analyzed using receiver operating characteristic(ROC).Results The plasma D-dimer level in the critical group was significantly higher than that in the severe group[(1785±420)ng/mL vs.(628±127)ng/mL,P<0.01],and that in the severe group was significantly higher than that in the non-severe group[(628±127)ng/mL vs.(277±87)ng/mL,P<0.01)].There were 14,3 and 0 deaths in the critical,severe and non-severe groups.The plasma D-dimer level in the death group was significantly higher than that in the survival group[(1257±364)ng/mL vs.(461±384)ng/mL,P<0.01],and the APACHE-Ⅱscore was also significantly higher than that in the survival group(17.7±4.6 vs.8.3±3.5,P<0.05).Pearson correlation analysis indicated that the plasma D-dimer level was positively correlated with APACHE-Ⅱscore(r=0.647,P<0.01).ROC analysis showed that when the plasma D-dimer level was at the threshold of 1498 ng/mL,the area under the ROC curve for predicting patient death was 0.91,the sensitivity was 75%,and the specificity was 93%.Conclusion The plasma D-dimer level was positively correlated with APACHE-Ⅱscore in patients with novel coronavirus pneumonia,which is of certai

关 键 词：新型冠状病毒肺炎 D-二聚体 急性生理和慢性健康评分 

分 类 号：R512.99[医药卫生—内科学]