劳力型热射病早期凝血及纤溶紊乱与预后的相关性研究  

Correlation between coagulation and fibrinolysis dysfunction and prognosis in early stage of exertional heat stroke

作　　者：邢令 李鑫[3] 辛天宇 刘树元 毛汉丁 宋青 李庆华[6] XING Ling;LI Xin;XIN Tianyu;LIU Shuyuan;MAO Handing;SONG Qing;LI Qinghua(Department of General Practice,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Medical School of Chinese PLA,Beijing 100089,China;Department of Emergency,3rd Medical Center of Chinese PLA General Hospital,Beijing 100039,China;Department of Emergency,6th Medical Center of Chinese PLA General Hospital,Beijing 100142,China;Intensive Care Unit,1st Medical Center of Chinese PLA General Hospital,Beijing 100089,China;Intensive Critical Unit,the 990th Hospital of Chinese PLA Logistical Support Force,Zhumadian,Henan 463000,China)

机构地区：[1]首都医科大学附属世纪坛医院全科医学科,北京100038 [2]解放军医学院,北京100089 [3]解放军总医院第三医学中心急诊医学科,北京100039 [4]解放军总医院第六医学中心急诊科,北京100142 [5]解放军总医院第一医学中心重症医学科,北京100089 [6]中国人民解放军联勤保障部队第九九〇医院重症医学科,河南驻马店463000

出　　处：《国际检验医学杂志》2023年第18期2244-2248,共5页International Journal of Laboratory Medicine

基　　金：军事医学创新工程专项(18CXZ024)。

摘　　要：目的 探讨劳力型热射病患者发病早期凝血及纤溶系统功能紊乱与其短期预后之间的关系。方法 回顾性分析劳力型热射病患者的临床资料,根据发病28 d的临床结局将患者分为死亡组及存活组。比较死亡组及存活组的临床特征及凝血、纤溶生物学标志物差异,进行Cox回归分析。对危险因素进行受试者工作特征曲线分析并绘制Kaplan-Meier生存曲线。结果 156例劳力型热射病患者中有28例死亡。与存活组相比,死亡组具有更高的核心体温、更低的收缩压(SBP)(P<0.05)。死亡组及存活组患者的凝血酶原时间国际标准化比例(PT-INR)、活化部分凝血活酶时间(APTT)、D-二聚体(DD)、血小板(PLT)、纤维蛋白原(Fib)、凝血酶原活动度(PTA)水平比较差异有统计学意义(P<0.001)。多因素Cox回归显示PT-INR、APTT、PLT和SBP为影响劳力型热射病患者生存时间的独立影响因素(P<0.05)。PT-INR、APTT、PLT预测劳力型热射病患者28 d死亡的诊断最佳截断值分别为1.70、44.75 s和85.0×10^(9)/L。以最佳截断值分组,PT-INR≥1.70者与PT-INR<1.70者比较,APTT≥44.75 s者与APTT<44.75 s者比较,PLT<85×10^(9)/L者与PLT≥85×10^(9)/L者比较,其预估生存时间差异均有统计学意义(P<0.001)。结论 尽管凝血和纤溶功能紊乱均与劳力型热射病严重程度有关,但严重的凝血活化(而不是纤溶亢进)可能最终导致了患者的预后不良。Objective To investigate the relationship between coagulation and fibrinolysis system dysfunction and short-term prognosis in patients with exertional heat stroke.Methods A total of 156 patients with exertional heat stroke were analyzed retrospectively.Patients were divided into survival group and non-survival group according to whether they died within 28 days.The differences of clinical features,coagulation and fibrinolysis biomarkers between the survival group and non-survival group were compared.The Cox regression analysis was performed on the statistically significant factors,and receiver operating characteristic(ROC)curve and Kaplan-Meier survival curve were drawn for the analysis of risk factors.Results A total of 28 out of 156 exertional heat stroke patients died.Compared with the survival group,the non-survival group had higher core body temperature and lower systolic blood pressure(SBP)(P<0.05).There were no significant differences in age,gender,previous history,environmental temperature and humidity(P>0.05).The international normalized ratio of prothrombin time(PT-INR),partially activated prothrombin time(APTT),D-dimer(DD),platelets(PLT),fibrinogen(Fib),prothrombin activity(PTA)levels of patients in non-survival group and survival group had significant statistical differences(P<0.001).Multivariate Cox regression results showed that PT-INR,APTT,PLT and SBP were independent influencing factors for 28-day prognosis of patients with exertional heat stroke(P<0.05).The cut off values for PT-INR,APTT and PLT were 1.70,44.75 s and 85.0×10^(9)/L,respectively.Grouped with the cut off value,there were statistically significant differences in the estimated survival time between patients with PT-INR≥1.7 and those with PT-INR<1.7,between patients with APTT≥44.75 s and those with APTT<44.75 s,and between patients with PLT<85×10^(9)/L and those with PLT≥85×10^(9)/L for exertional heat stroke(P<0.001).Conclusion The disorder of coagulation system and fibrinolysis system is related to the severity of exertional

关 键 词：劳力型热射病 凝血 纤溶 预后 

分 类 号：R87[医药卫生—运动医学]