凝血指标对特发性肺间质纤维化急性加重患者预后的评估价值  

Prognostic value of coagulation markers in patients with acute exacerbation of idiopathic pulmonary fibrosis

作　　者：张筠[1] 张晓萍[1] 刘颖[1] 邵润霞[1] 张铁栓[1] ZHANG Yun;ZHANG Xiao-ping;LIU Ying;SHAO Run-xia;ZHANG Tie-shuan(Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院呼吸与危重症医学科,郑州450014

出　　处：《医药论坛杂志》2023年第6期1-5,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200413)。

摘　　要：目的 探讨凝血指标对特发性肺间质纤维化急性加重期(AE-IPF)患者预后的评估价值。方法 选取郑州大学第二附属医院2014年3月—2021年12月住院的特发性肺间质纤维化急性加重期患者,根据预后分为好转组与死亡组,回顾性采集凝血四项、性别、有无基础疾病、白细胞计数(WBC)、中性粒细胞比率(NE%)等临床资料并进行CRUSADE评分,比较两组间有无差异;采用Spearman相关性分析评估PT与年龄、WBC、NE%、PA、ALB及CRUSADE评分有无相关性;行二元logistic回归找出影响AE-IPF患者预后的危险因素,并通过受试者工作特征曲线(ROC)了解其对评估预后的价值。结果 两组在PT、INR、%、年龄、WBC、NE%、PA、ALB、CRUSADE评分方面存在差异(P<0.05);PT与年龄(r=0.467,P=0.000)、NE%(r=0.353,P=0.007)、CRUSADE评分(r=0.407,P=0.002)呈正相关,与PA(r=-0.580,P=0.000)、ALB(r=-0.569,P=0.000)呈负相关;PT、INR、CRUSADE评分是影响患者预后的独立危险因素;PT预测患者预后的曲线下面积(AUC)为0.776,敏感度为61.5%,特异性为86.7%,最佳界值为14.05 s;PT结合CRUSADE评分评估患者预后的曲线下面积(AUC)为0.807,特异性为91.1%,敏感度为61.5%;根据PT的最佳界值分组,PT≥14.05 s组患者NE%、年龄及死亡率均高于PT<14.05 s组患者,而PA及ALB均低于PT<14.05 s组患者(P<0.05)。结论 PT是影响AE-IPF患者预后的独立危险因素,AE-IPF患者PT≥14.05 s即应引起临床重视,PT联合CRUSADE评分对预测AE-IPF患者的预后具有较好的临床价值。Objective To assess the prognostic value of coagulation markers in patients with acute exacerbation of idiopathic pulmonary fibrosis(AE-IPF).Methods Patients admitted to the Second Affiliated Hospital of Zhengzhou University from March 2014 to December 2021 were divided into the improved group and the death group according to their prognosis,coagulation markers,sex,presence or absence of underlying disease,white blood cell(WBC),neutrophil(NE%),CRUSADE score and other clinical data were collected retrospectively,the difference between the two groups were compared;Spearman correlation analysis was used to evaluate the correlation between PT and age,WBC,NE%,PA,ALB,CRUSADE score.Binary logistic regression was used to find out the independent risk factors affecting the prognosis,evaluate its clinical value for the patients through the receiver operating characteristic curve.Results There were significant differences in PT,age,WBC,NE%,INR,%,PA,Alb,CRUSADE score(P<0.05);PT was positively correlated with age(r=0.467,P=0.000),NE%(r=0.353,P=0.007),CRUSADE score(r=0.407,P=0.002),and negatively correlated with PA(r=-0.580,P=0.000) and ALB(r=-0.569,P=0.000);PT,INR and CRUSADE scores were independent risk factors for prognosis;The area under the curve(AUC) of PT prediction was 0.776,the specificity was 86.7%,the sensitivity was 61.5%,and the best cut-off value was 14.05s,PT combined with CRUSADE scores predicted an area under the curve(AUC) of 0.807 with a specificity of 91.1% and a sensitivity of 61.5%;in PT≥14.05 s group,age and mortality were higher while ALB and PA were lower than those of PT14.05 s Group(P<0.05).Conclusion PT is an independent risk factor affecting the prognosis of patients with AE-IPF.The PT≥14.05s in patients with AE-IPF should be taken seriously.The PT combined with the CRUSADE score was of clinical value in predicting the prognosis of patients with AE-IPF.

关 键 词：凝血指标 CRUSADE评分 特发性肺间质纤维化急性加重期 预后 

分 类 号：R563[医药卫生—呼吸系统]