组织型纤溶酶原激活物-纤溶酶原激活抑制物-1复合物判断脓毒症性凝血病患者预后的价值  

Value of tissue plasminogen activator-inhibitor 1 complex in judging the prognosis of patients with sepsis-induced coagulopathy

作　　者：张念清[1] 宋景春[2] 何龙平 林青伟 钟林翠 曾庆波 ZHANG Nianqing;SONG Jingchun;HE Longping;LIN Qingwei;ZHONG Lincui;ZENG Qingbo(Intensive Care Unit, Nanchang Hongdou Hospital of Traditional Chinese Medicine, Nanchang 330000, Jiangxi;Intensive Care Unit, the 908th Hospital of Joint Logistics Support Forces, PLA, Nanchang 330002, Jiangxi, China)

机构地区：[1]南昌市洪都中医院急重症二科,南昌330000 [2]中国人民解放军联勤保障部队第九〇八医院重症医学科,南昌330002

出　　处：《临床检验杂志》2021年第8期590-594,共5页Chinese Journal of Clinical Laboratory Science

基　　金：江西省卫生计生委科技计划(202140169)。

摘　　要：目的研究组织型纤溶酶原激活物-纤溶酶原激活抑制物-1复合物(t-PAIC)用于判断脓毒症性凝血病(SIC)患者预后的临床价值。方法对第九〇八医院重症医学科在2018年5月至2020年10月期间收治的91例SIC患者进行回顾性研究。根据入院后90天预后将患者分为生存组(n=49)和死亡组(n=42),比较两组患者的临床资料、常规凝血指标与新凝血四项的结果,并进行统计学分析。结果与SIC生存组患者相比,SIC死亡组患者的血栓调节蛋白(TM)和t-PAIC均升高(P<0.05)。Logistic回归分析显示t-PAIC是SIC患者死亡的独立危险因素。ROC曲线分析显示,t-PAIC、序贯器官衰竭评分(SOFA)、急性生理与慢性健康评分(APACHEⅡ)、t-PAIC+SOFA及t-PAIC+APACHEⅡ的ROC曲线下面积分别为0.722、0.677、0.647、0.740及0.713。当t-PAIC界值为18 ng/mL时,其敏感性、特异性、阳性预测值、阴性预测值分别为78.6%、59.2%、63.1%、75.3%。生存分析结果显示,t-PAIC>18 ng/mL患者的死亡风险是t-PAIC≤18 ng/mL患者的3.236倍。结论t-PAIC对SIC患者预后判断具有较高的价值。Objective To investigate the value of tissue plasminogen activator-inhibitor 1 complex(t-PAIC)in judging the prognosis of patients with sepsis-induced coagulopathy(SIC).Methods The clinical data of 91 patients with SIC from the Intensive Care Unit of the 908th Hospital during May 2018 and October 2020 were retrospectively analyzed.The patients were divided into the survival group(n=49)and death group(n=42)according to the prognosis on the 90th day,and the differences in baseline characteristics and coagulation markers between the two groups were compared and statistically analyzed.Results The levels of blood thrombomodulin(TM)and t-PAIC in the survival group were significantly higher than that in the death group(P<0.05).The results of Logistic regression analysis showed that t-PAIC was the independent risk factor of death in SIC patients.The receiver operating characteristic(ROC)curve analysis showed that the areas under the ROC curve of t-PAIC,sequential organ failure assessment(SOFA),acute physiology and chronic health evaluationⅡ(APACHEⅡ),t-PAIC combined with SOFA and t-PAIC combined with APACHEⅡwere 0.722,0.677,0.647,0.740 and 0.713,respectively.When the cut-off value of t-PAIC was 18 ng/mL,the sensitivity,specificity,positive predictive value and negative predictive value of t-PAIC in judging the prognosis of SIC patients were 78.6%,59.2%,63.1%and 75.3%,respectively.Survival analysis showed that the death risk of patients with t-PAIC>18 ng/mL was 3.236 times higher than that with t-PAIC≤18 ng/mL.Conclusion t-PAIC has high value in judging the prognosis of SIC patients.

关 键 词：组织型纤溶酶原激活物-纤溶酶原激活抑制物-1复合物 脓毒症 凝血功能紊乱 预后 

分 类 号：R446[医药卫生—诊断学]