抗凝血酶-Ⅲ获得性降低对脓毒症患者死亡风险的预测价值  

Predictive value of acquired antithrombin-Ⅲreduction on risk of mortality in patients with sepsis

作　　者：孙文 何德英[1] 詹丽英[2] 王常永[2] 张迪[2] 石昭坤 李光[2] SUN Wen;HE Deying;ZHAN Liying;WANG Changyong;ZHANG Di;SHI Zhaokun;LI Guang(Department of Geriatrics,Chongqing Hospital of Traditional Chinese Medicine,Chongqing,400021,China;Department of Critical Care Medicine,Renmin Hospital of Wuhan University)

机构地区：[1]重庆市中医院老年病科,重庆400021 [2]武汉大学人民医院重症医学Ⅰ科

出　　处：《临床急诊杂志》2022年第2期121-125,共5页Journal of Clinical Emergency

摘　　要：目的:分析获得性抗凝血酶-Ⅲ(AT-Ⅲ)降低对脓毒症患者死亡风险预测的敏感度和特异度,为临床救治脓毒症患者、降低脓毒症患者死亡风险提供依据。方法:回顾性分析2020年6月-2021年9月期间武汉大学人民医院重症医学科收治的141例脓毒症患者病历资料。根据患者预后情况分为脓毒症存活组和死亡组,比较两组患者的急性生理与慢性健康Ⅱ(APACHEⅡ)评分、全身感染相关性器官功能衰竭评价系统(SOFA)评分、入住ICU时的AT-Ⅲ值、住ICU期间是否行机械通气、是否输血、是否使用血管活性药、感染部位、病原菌及住ICU时长等。结果:141例患者中,死亡54例,存活87例,死亡组的脓毒症患者的AT-Ⅲ值及住ICU时间明显低于生存组患者,APACHEⅡ评分、SOFA评分、凝血酶原时间(PT)、部分活化凝血酶原时间(APTT)、总胆红素(TBIL)、直接胆红素(DBIL)等均显著高于生存组,对上述有统计学意义的单因素纳入logistic回归模型中进行多因素分析发现只有AT-Ⅲ值及住ICU时间差异有统计学意义,作ROC曲线发现AT-Ⅲ诊断脓毒症患者死亡风险高的阈值为≤42.5%。结论:获得性AT-Ⅲ降低可作为脓毒症患者预后判断的有效指标,当脓毒症患者的AT-Ⅲ下降至42.5%及以下时,提示患者病死率明显升高。Objective:To explore the predictive value of acquired AT-Ⅲreduction on risk of mortality in patients with sepsis and provide a basis for clinical treatment of sepsis patients and reduction of risk of death in patients with sepsis.Methods:One hundred and forty one patients with sepsis treated in the Department of Critical Medicine of Wuhan University People’s Hospital from June 2020 to September 2021 were enrolled for the retrospective analysis.According to the patient’s prognosis,patients were divided into sepsis survival group and death group.The APACHEⅡscore,SOFA score,AT-Ⅲvalue at ICU,access to mechanical ventilation during residence in ICU,whether to accept blood transfusion,application of vascular active drugs,infection site,pathogens and ICU duration were compared.Results:Of the 141 enrolled patients with sepsis,54 died and 87 survived,the AT-Ⅲvalue and residence time in ICU of sepsis patients in the death group were significantly lower than those in the survival group,and the APACHEII score,SOFA score,PT,APTT,total bilirubin(TBIL),direct bilirubin(DBIL)and so on were significantly higher than those in the survival group.Multivariate logistic regression was used to analyze the statistically significant single factors and found that there were statistical differences of the AT-Ⅲvalue and ICU length of stay between the two groups.ROC curve analysis showed that the HIGH threshold for the death risk of patients diagnosed with sepsis was found to be≤42.5%.Conclusion:The reduction of acquired AT-Ⅲcan be used as an effective indicator of prognosis in patients with sepsis,and AT-Ⅲunder 42.5%in patients with sepsis may indicate increased mortality rate.

关 键 词：脓毒症 抗凝血酶-Ⅲ 死亡风险 预后 

分 类 号：R459.7[医药卫生—急诊医学]