血栓调节蛋白对脓毒症性凝血病的诊断价值  

Diagnostic value of thrombomodulin in sepsis-induced coagulopathy

作　　者：曾庆波 张念清[2] 余婷 何龙平 林青伟 钟林翠 邓星平 宋景春 Zeng Qing-Bo;Zhang Nian-Qing;Yu Ting;He Long-Ping;Lin Qing-Wei;Zhong Lin-Cui;Deng Xing-Ping;Song Jing-Chun(Intensive Care Unit,the 908th Hospital of Chinese PLA Logistical Support Force,Nanchang 330002,China;Intensive Care Unit,Nanchang Hongdu Hospital of TCM,Nanchang 330000,China)

机构地区：[1]解放军联勤保障部队第908医院重症医学科,南昌330002 [2]南昌市洪都中医院重症医学科,南昌330000

出　　处：《解放军医学杂志》2021年第6期593-597,共5页Medical Journal of Chinese People's Liberation Army

基　　金：江西省卫生计生委科技计划项目(202140169)。

摘　　要：目的研究血栓调节蛋白(TM)对脓毒症性凝血病(SIC)的临床诊断价值。方法选取解放军联勤保障部队第908医院重症医学科2018年5月-2019年10月收治的172例脓毒症患者。按国际血栓与止血学会(ISTH)2017年发布的SIC诊断标准将患者分为SIC组(n=68)与普通脓毒症(SA)组(n=104),比较两组患者的临床资料[性别、年龄、急性生理与慢性健康评分(APACHEⅡ)、序贯器官衰竭评分(SOFA)、平均动脉压(MAP)、血乳酸(Lac)、合并疾病、ICU病死率及ICU住院时间]、常规凝血指标[血浆凝血酶原时间(PT)、国际标准化比值(INR)、血小板计数(PLT)]及凝血分子标志物[组织型纤溶酶原激活剂-纤溶酶原激活剂抑制剂-1复合物(t-PAIC)、血栓调节蛋白(TM)、凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2抗纤溶酶复合物(PIC)]的变化,应用logistic回归分析SIC的危险因素,采用受试者工作特征曲线(ROC)分析凝血分子标志物对SIC的诊断效能,Kaplan-Meier生存分析法比较不同TM分组患者的生存率。结果与SA组的TM[10.5(7.8~14.9)TU/ml]、TAT[8.6(4.8~18.0)ng/ml]及t-PAIC[11.6(7.1~22.2)ng/ml]比较,SIC组的TM[15.0(10.5~25.9)TU/ml]、TAT[15.1(5.7~34.6)ng/ml]及t-PAIC[22.1(11.0~39.1)ng/ml]水平均明显升高,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,TM及血乳酸升高是SIC的独立危险因素(P<0.05)。ROC曲线分析显示,TM诊断SIC的曲线下面积为0.685;当TM界值为11.5 TU/ml时,其敏感度、特异度、阳性预测值、阴性预测值分别为72.1%、61.5%、55.2%、77.1%。生存分析结果显示,TM>11.5 TU/ml的脓毒症患者死亡风险是TM≤11.5 TU/ml脓毒症患者的3.61倍。SOFA≥2分且TM>11.5 TU/ml患者的病死率为47.2%(42/89),不符合该标准患者的病死率为14.5%(12/83);符合ISTH-SIC诊断标准的患者病死率为47.1%(32/68),不符合该标准的患者病死率为21.2%(22/104)。结论TM>11.5 TU/ml时脓毒症患者死亡风险升高,联合SOFA≥2分可为诊断SIC提�Objective To explore the diagnostic value of thrombomodulin(TM)for sepsis-induced coagulopathy.Methods A prospective study was conducted on 172 hospitalized patients with sepsis from intensive care units(ICU)of the 908 th Hospital of Chinese PLA Logistical Support Force between May 2018 and October 2019.All the subjects were divided into sepsisinduced coagulopathy(SIC)group(n=68)and sepsis alone(SA)group(n=104)according to the diagnostic criteria of International Society on Thrombosis and Haemostasis.Baseline characteristics[gender,age,acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA),mean arterial pressure(MAP),lactate(Lac),comorbidity,ICU mortality and length of stay in ICU],coagulation tests[prothrombin time(PT),international normalized ratio(INR),platelet count(PLT)]and molecular markers of coagulation[tissue plasminogen activator-inhibitor complex(t-PAIC),TM,thrombinantithrombin complex(TAT),plasmin-α2-plasmin inhibitor complex(PIC)]were compared.Multivariate logistic regression analysis was used to identify risk factors for SIC.The effectiveness of TM in diagnosing SIC was analyzed by ROC curve analysis.Kaplan-Meier analysis was used to analyze the cumulative sur vival rate.Results Compared with TM[10.5(7.8-14.9)TU/ml],TAT[8.6(4.8-18.0)ng/ml]and t-PAIC[11.6(7.1-22.2)ng/ml]in SA group,TM[15.0(10.5-25.9)TU/ml],TAT[15.1(5.7-34.6)ng/ml]and t-PAIC[22.1(11.0-39.1)ng/ml]in SIC group were significantly increased(P<0.05).Multivariate logistic regression analysis showed that TM and Lac were the independent risk factors for SIC.The area under the curve of TM for diagnosing SIC was 0.685 and its diagnostic threshold was 11.5 TU/ml.Its diagnostic sensitivity,specificity,positive predictive value and negative predictive value were 72.1%,61.5%,55.2%and 77.1%,respectively.Kaplan-Meier analysis revealed that the death risk of patients with sepsis in TM>11.5 TU/ml group was 3.61 times higher than TM≤11.5 TU/ml group.The mortalities of patients who met or didn’t meet t

关 键 词：血栓调节蛋白 脓毒症 凝血病 诊断 

分 类 号：R552[医药卫生—血液循环系统疾病]