革兰阳性球菌感染的脓毒症患者纤维蛋白原及凝血因子Ⅺ水平与近期预后的相关性  

Correlation of fibrinogen and coagulation factorⅪlevels with short-term prognosis in patients with sepsis infected by Gram-positive cocci

作　　者：王静静[1] 肖东[1] WANG Jingjing;XIAO Dong(Department of Critical Care Medicine,People′s Hospital of Xinjiang Uygur Autonomous Region,Urumqi,Xinjiang 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院重症医学科,新疆乌鲁木齐830001

出　　处：《国际检验医学杂志》2022年第4期451-454,459,共5页International Journal of Laboratory Medicine

基　　金：新疆维吾尔自治区自然科学基金项目(2018D01C304)。

摘　　要：目的对革兰阳性球菌感染的脓毒症患者纤维蛋白原(Fib)、凝血因子Ⅺ(FⅪ)水平与近期预后的相关性进行分析。方法将2015年1月至2019年12月该院诊治的198例革兰阳性球菌感染的脓毒症患者纳入研究,根据患者在诊断后30 d内是否死亡将其分为死亡组及存活组,比较两组患者的年龄、性别及感染部位等一般资料,并对患者的凝血功能等相关实验室指标进行比较,采用多因素Logistic回归对影响患者近期预后的因素进行分析,应用受试者工作特征(ROC)曲线评估上述影响因素在预测革兰阳性球菌感染的脓毒症患者近期预后中的价值。结果纳入的198例患者最终有31例患者于30 d内死亡,167例存活。死亡组患者的年龄、急性生理和慢性健康状况(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、合并脑卒中的比例及Fib水平均明显高于存活组,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)明显长于存活组,血小板计数(PLT)、FⅪ水平明显低于存活组,差异均有统计学意义(P<0.05)。两组患者的性别、体质量指数(BMI)等一般资料相比,差异无统计学意义(P>0.05)。多因素Logistic回归分析提示,高SOFA评分、高APACHEⅡ评分及高Fib水平是影响患者近期预后的独立危险因素(P<0.05),而高PLT及高FⅪ则是影响患者近期预后的保护因素(P<0.05)。ROC曲线分析提示,Fib联合FⅪ预测患者近期预后的曲线下面积(AUC)为0.931,明显高于SOFA评分、APACHEⅡ评分、PLT、Fib及FⅪ单一检测(P<0.05),此时诊断的灵敏度为83.9%,特异度为91.6%。结论革兰阳性球菌感染的脓毒症患者体内Fib及FⅪ水平是患者近期预后的影响因素,且二者联合诊断可有效对脓毒症患者近期预后进行预测。Objective To analyze the correlation between the levels of fibrinogen and coagulation factorⅪ(FⅪ)in the patients with sepsis infected by Gram-positive cocci and their short-term prognosis.Methods One hundred and ninety-eight cases of sepsis infected Gram-positive cocci in this hospital from January 2015 to December 2019 were included in the study and divided into the death group and survival group according to whether they died within 30 d after diagnosis.The general data such as age,gender and infection site were compared between the two groups,and the related laboratory indicators such as the coagulation function in the patients were compared.The multivariate Logistic regression was used to analyze the factors affecting the short-term prognosis of the patients,and the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of the above factors in predicting the short-term prognosis of the patients with sepsis infected by Gram-positive cocci.Results Among 198 included cases,31 cases finally died within 30 d and 167 cases survived.The age,APACHEⅡscore,SOFA score,proportion of complicating brain stroke and Fib level in the death group were significantly higher than those in the survival group,the PT and APTT were longer than those of the survival group,the levels of PLT and FⅪwere significantly lower than those in the survival group,and the differences were statistically significant(P<0.05).There were no statistically significant differences in the gender,BMI and other general clinical data between the two groups(P>0.05).The multivariate Logistic regression analysis showed that the high SOFA score,high APACHEⅡscore and high Fib level were the independent risk factors affecting the prognosis of the patients(P<0.05),while high PLT and high FⅪlevels were the protective factors affecting the prognosis of the patients(P<0.05).The ROC curve analysis indicated that the area under the currve(AUC)of Fib combined with FⅪfor predicting the short-term prognosis was 0.931,which was s

关 键 词：革兰阳性球菌 脓毒症 纤维蛋白原 凝血因子Ⅺ 

分 类 号：R631.2[医药卫生—外科学]