血栓四项检测在急诊内科肺部疾病患者疾病严重程度判断中的价值  

Value of thrombus 4-item detection for judging severity degree in patients with pulmonary diseases of internal medicine emergency department

作　　者：金宁 徐晓芬 张晓飞 纪凌云 JIN Ning;XU Xiaofen;ZHANG Xiaofei;JI Lingyun(Department of Clinical Laboratory,Affiliated Shanghai East Hospital,Tongji University,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院医学检验科,上海200120

出　　处：《检验医学与临床》2023年第1期81-84,共4页Laboratory Medicine and Clinic

基　　金：上海市公共卫生体系建设三年(2020-2022年)行动计划(GWV-10.1-XK04)。

摘　　要：目的探讨血栓四项[凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2纤溶酶抑制物复合物(PIC)、血栓调节蛋白(TM)、组织纤溶酶原激活物/纤溶酶原激活物抑制剂-1复合物(t-PAIC)]检测在肺部疾病患者疾病严重程度判断中的价值,为控制医院感染、合理使用抗菌药物提供依据。方法分析该院急诊内科2019年3-9月收治的肺部疾病患者39例,分为肺病组25例,肺病合并脓毒症组14例,比较两组患者传统凝血指标凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)、纤维蛋白降解产物(FDP),血栓四项TM、TAT、PIC、t-PAIC,降钙素原(PCT)并将差异有统计学意义的指标绘制受试者工作特征(ROC)曲线,比较各指标的诊断效能。结果肺病组与肺病合并脓毒症组的传统凝血指标PT、APTT、D-D、FDP,血栓四项TM、TAT、PIC、t-PAIC及PCT比较,差异均有统计学意义(P<0.05),两组TT、FIB比较,差异无统计学意义(P>0.05)。ROC曲线分析结果显示,血栓四项TM的曲线下面积(AUC)为0.9200,PCT为0.9435,均具有较好的诊断效能,接下来依次为FDP、D-D、TAT、PT、t-PAIC、APTT、PIC,AUC分别为0.8914、0.8700、0.8343、0.8229、0.8229、0.7214、0.6857。结论血栓四项的水平变化可有效评估肺部疾病的严重程度,TM对肺部疾病合并脓毒症的鉴别诊断具有较好的参考价值,有望成为继PCT之后的新型标志物。Objective To explore the value of thrombus 4-items[thrombin antithrombin complex(TAT),α2 plasminase inhibitor complex(PIC),thrombomodulin(TM),tissue plasminogen activator-plasminogen activator inhibitor-1 complex(t-PAIC)]in judging severity degree in the patients with pulmonary diseases so as to provide a basis for controlling nosocomial infection and rationally using antibiotic drugs.Methods Thirty-nine patients with pulmonary diseases admitted to the internal medicine emergency department of the hospital from March to September 2019 were analyzed,and divided into the pulmonary disease group(25 cases)and pulmonary disease complicating sepsis group(14 cases).The levels of traditional coagulation markers PT,APTT,TT,FIB,D-D,FDP,thrombus 4-items TM,TAT,PIC,t-PAIC,and procalcitonin(PCT)were compared between the two groups,and the indicators of the statistical differences were drawn the receiver operating characteristic(ROC)curves.Then the detection efficiencies were compared among the various indicators.Results The traditional indicators PT,APTT,D-D and FDP,thrombus 4-indicators TM,TAT,PIC,t-PAIC and PCT had statistical differences between the pulmonary disease group and pulmonary disease complicating sepsis group(P<0.05),but there were no statistically significant differences in TT and FIB between the two groups(P>0.05).The ROC curve results analysis showed that the area under the curve(AUC)of TM in thrombus 4-items was 0.9200 and the AUC of PCT was 0.9435,which had better diagnostic efficiency,followed by FDP,D-D,TAT,PT,t-PAIC,APTT and PIC,their AUC values were 0.8914,0.8700,0.8343,0.8229,0.8229,0.7214 and 0.6857,respectively.Conclusion The change of thrombus 4-items levels will effectively evaluate the severity of pulmonary disease.TM has a good reference value for the differential diagnosis of pulmonary disease complicating sepsis,and is expected to become a new type marker after PCT.

关 键 词：慢性阻塞性肺疾病 脓毒症 凝血酶-抗凝血酶复合物 纤溶酶-α2纤溶酶抑制物复合物 血栓调节蛋白 组织纤溶酶原激活物/纤溶酶原激活物抑制剂-1复合物 

分 类 号：R446.11[医药卫生—诊断学]