红细胞碎片计数与红细胞碎片比例对脓毒症患者预后评估的应用研究  

Study on the value of fragmented red blood cell and fragmented red blood cells percentage for predicting the prognosis of sepsis patients

作　　者：陈辉[1] 宋开源 彭灿辉[1] Chen Hui;Song Kaiyuan;Peng Canhui(Department of Clinical Laboratory,the Third Xiangya Hospital of Central South University,Changsha 410013,China;Department of Pathophysiology,Xiangya Medical School,Central South University,Changsha 410000,China)

机构地区：[1]中南大学湘雅三医院检验科,长沙410013 [2]中南大学湘雅医学院病理生理学系,长沙410000

出　　处：《中华预防医学杂志》2023年第8期1246-1252,共7页Chinese Journal of Preventive Medicine

基　　金：湖南省普惠性政策与创新环境建设计划-临床医疗技术创新引导项目(2020SK53617);湖南省自然科学基金-面上项目(2021JJ30995);湖南省卫生健康委科研计划课题(B202311007539)。

摘　　要：探讨红细胞碎片计数(FRCs)、红细胞碎片比例(FRC%)对脓毒症预后的诊断效能。采用前瞻性研究,选取2022年6月1日至2023年1月10日在中南大学湘雅三医院重症医学科收治的符合要求的101例脓毒症患者作为研究对象,根据患者30 d结局分为生存组和死亡组。比较脓毒症生存组与死亡组的临床资料和FRCs、FRC%、血小板(PLT)等实验室指标。以是否发生死亡为因变量,将脓毒症患者的病例资料和实验室指标先进行单因素logistic回归,后进行多因素logistic回归分析以分析影响预后的因素,对纳入模型的各参数绘制受试者工作特征曲线(ROC)并计算曲线下面积(AUC),评价单独使用和联合使用各参数对脓毒症患者死亡的预测效能。结果显示,脓毒症死亡组的FRCs、FRC%、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D二聚体要明显高于生存组,PLT明显低于生存组(Z或t值分别为-3.712,-3.793,-2.119,-2.007,-2.209,均P<0.05),FRCs或FRC%、PLT可能是脓毒症患者30 d死亡的风险预测指标。PLT预测脓毒症患者死亡的AUC为0.727(95%CI 0.629~0.811,P<0.01),最佳截断值为137×10^(9)/L,敏感度为83.87%,特异度为57.14%。FRCs预测脓毒症患者死亡的AUC为0.732(95%CI 0.635~0.815,P<0.01),最佳截断值为10.1×10^(9)/L,敏感度为77.42%,特异度为67.14%。FRC%预测脓毒症患者死亡的AUC为0.737(95%CI 0.640~0.820,P<0.01),最佳截断值为0.34%,敏感度为77.42%,特异度为65.71%。综上,PLT、FRCs、FRC%在脓毒症的预后中具有较大的应用价值。当脓毒症患者PLT、FRCs、FRC%检查结果分别大于137×10^(9)/L、10.1×10^(9)/L、0.34%时,需要及时对病情进行全面综合考虑,尽早采取必要合理的临床干预措施以预防患者死亡。To explore the predictive efficacy of fragmented red blood cells(FRC)and fragmented red blood cells percentage(FRC%)with regarding for the prognosis of septic patients,along with comparing with routine coagulation parameters.A prospective study was conducted.A total of 101 patients with sepsis who met the requirements admitted to the Intensive Care Department of the Third Xiangya Hospital of Central South University from June 1,2022 to January 10,2023 were selected as the research objects,they were divided into survival group and death group according to the 30-day prognosis.The clinical data and laboratory indexes such as FRCs,FRC% and Platelet(PLT)were compared between the survival group and the death group.Univariate logistic regression analysis was used first,then multivariate logistic regression analysis was used to analyze the factors affecting the prognosis.Receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of each parameter in the regression model for the prognosis of sepsis.The results showed that the levels of FRCs,FRC%,prothrombin time(PT),activated partial thromboplastin time(APTT)and D-dimer in death group were significantly higher than those in survival group,and PLT in death group were significantly lower than those in survival group(Z or t values were-3.712,-3.793,-2.119,-2.007,-2.209,all P<0.05).FRCs or FRC% and PLT could be independent predictors of 30-day mortality.The area under the ROC curve(AUC)of PLT for predicting 30-day death in sepsis patients was 0.727(95%CI 0.629-0.811,P<0.01),when the optimal threshold was 137×10^(9)/L,the sensitivity was 83.87% and the specificity was 57.14%.The AUC of FRCs for predicting 30-day death in sepsis patients was was 0.732(95%CI 0.635-0.815,P<0.01),when the optimal threshold was 10.1×10^(9)/L,the sensitivity was 77.42%,and the specificity was 67.14%.The AUC of FRC% for predicting 30-day death in sepsis patients was 0.737(95%CI 0.640-0.820,P<0.01),When the optimal threshold was 0.34%,the sensitivity was 77.42%,and

关 键 词：脓毒症 凝血功能障碍 血小板 红细胞碎片计数 红细胞碎片比例 

分 类 号：R459.7[医药卫生—急诊医学]