老年创伤患者凝血酶激活纤溶抑制物水平与脓毒症风险的相关性分析  

Correlation between the level of thrombin-activated fibrinolysis inhibitor and the risk of sepsis in elderly trauma patients

作　　者：丁汝梅 赵国强 胥丰 张朝贵 廖平 梁光颖 董志军 DING Rumei;ZHAO Guoqiang;XU Feng;ZHANG Chaogui;LIAO Ping;LIANG Guangying;DONG Zhijun(Department of Surgery,Guizhou Orthopaedic Hospital,Guizhou,550000,China)

机构地区：[1]贵州省骨科医院外科,贵州550000

出　　处：《临床急诊杂志》2021年第5期329-334,共6页Journal of Clinical Emergency

基　　金：贵州省贵阳市科技计划项目(No:[2019]9-5-17)。

摘　　要：目的:分析中老年创伤患者凝血酶激活纤溶抑制物水平与脓毒症风险的相关性分析。方法:入选2018年7月—2020年7月期间于我院急诊外科进行诊治的中老年创伤患者460例进行分析,根据患者在住院期间是否发生脓毒症分为对照组及脓毒症组。比较两组的一般资料、实验室指标[包括凝血酶激活的纤溶抑制物(TAFI)、D-二聚体(DD)等]等项目;应用多因素Logistic回归分析影响创伤患者发生脓毒症的相关因素,应用ROC曲线分析各因素预测创伤患者发生脓毒症的风险。结果:纳入研究的460例创伤患者,有14例脱落,有效分析446例,其中55例患者在治疗过程中出现脓毒症被列为脓毒症组,391例患者为对照组,脓毒症发生率为12.33%。两组的性别、病程、WBC和PLT等临床资料比较,差异无统计学意义(P>0.05);但脓毒症组年龄、PCT、CRP及DD均高于对照组(P<0.05);且脓毒症组ATⅢ及TAFI均低于对照组(P<0.05);多因素Logistic回归分析显示:PCT、CRP和DD是影响创伤患者发生脓毒症的独立危险因素,而TAFI是影响创伤患者发生脓毒症的保护性因素。ROC曲线显示:TAFI预测创伤患者发生脓毒症的诊断效能明显高于PCT、CRP和DD的预测价值,其最佳截点:≤22.92μg/mL,此时诊断的敏感度为78.23%、特异度为85.92%。结论:中老年创伤患者早期TAFI与发生脓毒症风险呈负相关关系,早期监测有助于临床及时调整治疗方案,预防脓毒症的发生及改善创伤患者的预后。Objective: To analyze the correlation between the level of thrombin-activated fibrinolysis inhibitor and the risk of sepsis in middle-aged and elderly patients with trauma. Methods: Four hundred and sixty cases of middle-aged and elderly trauma patients treated in the emergency surgery department of our hospital from July 2018 to July 2020 were selected and analyzed. Patients were divided into control group and sepsis group according to whether sepsis occurred during hospitalization. The general information, laboratory indexes, including thrombin activated fibrinolysis inhibitor(TAFI), D-dimer(DD) and other items of the two groups were compared.Multivariate Logistic regression was used to analyze the factors affecting sepsis in trauma patients, and ROC curve was used to predict the risk of sepsis in trauma patients. Results: Among the 460 trauma patients included in the study, 14 cases fell off, and 446 cases were effectively analyzed. Among them, 55 patients with sepsis during treatment were classified as the sepsis group, and 391 patients as control group.The incidence of sepsis was 12.33%. There was no statistically significant difference in gender, course of disease, WBC, PLT and other clinical data between the two groups(P>0.05);But the age, PCT, CRP and DD of the sepsis group were all higher than those of the control group(P<0.05);ATⅢ and TAFI in sepsis group were lower than those in control group(P<0.05). Multivariate Logistic regression analysis showed that PCT, CRP and DD were independent risk factors for sepsis in trauma patients, while TAFI was a protective factor for sepsis in trauma patients. The ROC curve showed that TAFI was significantly more effective in predicting sepsis in trauma patients than PCT, CRP and DD, and the optimal cut-off point was ≤22.92 μg/mL. The sensitivity and specificity of TAFI were 78.23% and 85.92%, respectively. Conclusion: Early TAFI in middle-aged and elderly trauma patients is negatively correlated with the risk of sepsis. Early monitoring is conducive to timely cl

关 键 词：凝血酶激活的纤溶抑制物 创伤 脓毒症 D-二聚体 

分 类 号：R631[医药卫生—外科学]