真菌血症患者凝血功能的变化及预后的意义  

Clinical significance of changes in coagulation function and its prognosis in patients with fungemia

作　　者：黄奔 范坤 崔婷 刘成成 HUANG Ben;FAN Kun;CUI Ting;LIU Chengcheng(Department of Laboratory Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210009,Jiangsu,China)

机构地区：[1]南京医科大学第一附属医院检验学部,南京210009

出　　处：《临床检验杂志》2023年第12期900-904,共5页Chinese Journal of Clinical Laboratory Science

基　　金：江苏省实验诊断学重点实验室(ZDXKB202239)。

摘　　要：目的 研究患者在住院期间发生真菌血症后血液相关参数及凝血功能指标的变化,分析其变化的临床意义及与患者预后的影响。方法 回顾性分析2018年12月至2022年10月期间,经实验室检测首次血培养阳性且为真菌血流感染的患者,收集其入院时和血培养阳性时的血液相关参数及凝血功能指标的检测结果,分析患者血培养阳性时与入院时各临床参数的差异。根据患者预后结局,将患者分为存活组和死亡组,用Mann-Whitney U检验比较两组之间各指标的差异。Logistic回归分析用于分析死亡相关危险因素。结果 共有87例患者纳入分析,与入院时的检测水平相比,患者在血培养阳性时,其单核细胞计数、淋巴细胞计数和PLT水平显著降低,差异有统计学意义(P<0.001);而血小板相关参数MPV、PDW水平均显著升高,差异有统计学意义(P<0.05);凝血功能指标PT、APTT、D-dimer水平明显升高,差异有统计学意义(P<0.05)。此外,死亡组患者在血培养阳性时外周血PLT明显低于存活组患者(P=0.022),凝血功能指标PT、APTT和TT水平均显著高于存活组患者(P<0.05),差异具有统计学意义。Logistic回归分析显示,患者死亡与低水平的PLT具有相关性(OR=1.46,95%CI:1.08~1.97,P=0.01)。结论 住院患者发生真菌感染后PLT降低,PT、APTT延长,低水平的PLT与患者的预后相关,监测其变化有助于辅助判断患者的病情和预后。Objective To investigate the changes of blood related parameters and coagulation function indicators in patients with fungemia during hospitalization,and analyze the clinical significance of these changes and their impact on the patients′ prognosis.Methods The patients with positive fungus blood culture for the first time and diagnosed as fungal bloodstream infection during December 2018 and October 2022 were retrospectively analyzed.Their blood related parameters and coagulation function indicators at admission and the time of positive blood culture were collected,and the differences of these clinical parameters were analyzed.The patients were divided into the survival group and death group based on their prognosis,and the differences in clinical parameters between the two groups were compared using the Mann-Whitney U test.The Logistic regression analysis was used to analyze the risk factors related to death.Results A total of 87 patients were enrolled in the study.The patients′ results of monocyte count,lymphocyte count,and platelet(PLT) at the time of positive blood culture were significantly lower than those at admission(P<0.001),while the levels of platelet-associated parameters MPV and PDW were significantly increased(P<0.05).The levels of coagulation function indicators such as PT,APTT,and D-dimer at the time of positive blood culture were significantly higher than those at admission(P<0.05).Compared with the the survival group,the peripheral blood PLT count in the death group at the time of positive blood culture was significantly reduced(P=0.022),while the PT,APTT and TT levels were significantly increased(P<0.05).Logistic regression analysis showed that the death of patients was significantly correlated with the lower level of PLT(OR=1.46,95%CI:1.08-1.97,P=0.01).Conclusion The fungal infection in hospitalized patients can lead to a decrease in PLT count and the prolongation of PT and APTT.Low levels of PLT are associated with the patients′ prognosis,and monitoring its changes can assist in assessi

关 键 词：真菌感染 凝血功能 预后 

分 类 号：R446[医药卫生—诊断学]