成人支原体肺炎患者凝血功能变化及其与外周血单核细胞百分比的相关性  

Relationship between the percentage of monocytes in peripheral blood and the changes of coagulation in adult mycoplasma pneumonia

作　　者：何婧瑜[1] 王晶[1] He Jing-yu;Wang Jing(Emergency Department,Xuanwu Hospital,Capital Medical University,National Clinical Research Center for Geriatric Diseases(Xuanwu Hospital),Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院急诊科,国家老年疾病临床医学研究中心(宣武医院),北京100053

出　　处：《中国急救医学》2021年第3期191-195,共5页Chinese Journal of Critical Care Medicine

基　　金：国家科技部重点研发计划(2018YFC1312000)。

摘　　要：目的分析成人支原体肺炎患者凝血指标改变的情况,探讨外周血单核细胞百分比(the percentage of peripheral blood mononuclear cells,MO%)与凝血功能变化的相关性。方法回顾性分析2016年1月至2018年12月首都医科大学宣武医院急诊科普通病房住院的95例成人支原体肺炎患者入院24 h内血常规、血液生化、凝血功能、抗体滴度、社区获得性肺炎严重程度(CURB-65)评分及病程等指标,评估MO%与上述指标的相关性。结果成人支原体肺炎患者存在各种类型的凝血异常,70.53%患者血浆D-二聚体(D-dimer)增高。MO%与患者凝血指标:凝血酶原时间活动度(prothrombin time activity,PTA)缩短、凝血酶原时间(prothrombin time,PT)延长、国际标准化比值(international normalized ratio,INR)延长、D-dimer增高呈正相关;与病程、CURB-65评分呈负相关(P <0.05)。逐步Logistic回归发现,MO%为D-dimer增高的独立预测因素[Exp(B) 95%CI 0.832(0.697~0.993),P=0.041]。受试者工作特征(receiver operating characteristic,ROC)曲线发现,MO%对PTA缩短、PT延长、INR延长、D-dimer增高及病程延长具有预测价值(P <0.05)。结论在成人支原体肺炎中,炎性单核细胞与凝血指标改变相关,影响病情严重程度及病程长短,单核细胞可能为联系凝血和炎症的桥梁。Objective To explore the relationship between the percentage of peripheral blood mononuclear cells( MO%) and the change of coagulation in the patients with adult mycoplasma pneumonia. Methods 95 patients with adult mycoplasma pneumonia,hospitalized in the general ward of the emergency department,Xuanwu Hospital,Capital Medical University,from January 2016 to December 2018 were enrolled. The correlations between MO% and other indicators( such as: blood routine with 24 h after admission biochemical indicators,coagulation markers,CURB-65 score,antibody titers,the course of disease,et al.) were analyzed retrospectively. Results There were various types of coagulation abnormalities in the patients after mycoplasma infection,and the D-dimer increased in 70. 53% of the patients. MO% were negatively correlated with CURB-65 score and the course of disease,whereas positively correlated with prothrombin time activity( PTA),prothrombin time( PT),international normalized ratio( INR) and D-dimer( P < 0. 05). Stepwise Logistic regression showed that MO% was an independent predictor of D-dimer increase[Exp( B) 95% CI 0. 832( 0. 697-0. 993),P = 0. 041]. Receiver operating characteristic curves( ROC curves) showed that MO% had predictive value for shortening PTA,prolonging PT and INR,increasing D-dimer and the long-course of disease( P < 0. 05). Conclusions MO% is associated with blood coagulation,CURB-65 score,and disease courses in the patients with mycoplasma pneumonia,and may serve as a bridge to link inflammation with coagulation.

关 键 词：支原体肺炎 单核细胞(MO) 凝血功能障碍 D-二聚体(D-dimer) 成人 

分 类 号：R563.1[医药卫生—呼吸系统]