D-二聚体和乳酸对眼镜蛇咬伤溃疡坏死的预警价值研究  

Early warning value of D-dimer and lactic acid on ulcer necrosis in patients bitten by cobra

作　　者：刘彦伶 周维 江维晗 陈莉[1] LIU Yanling;ZHOU Wei;JIANG Weihan;CHEN Li(Nanhua Hospital Affiliated to University of South China,Hengyang 421002,China)

机构地区：[1]南华大学附属南华医院,湖南衡阳421002

出　　处：《临床医药实践》2024年第2期148-152,160,共6页Proceeding of Clinical Medicine

摘　　要：目的:探讨D-二聚体(D-D)和血乳酸(Lac)水平对眼镜蛇咬伤导致溃疡坏死的相关性及预警价值。方法:选取2021年5月—2022年11月南华大学附属南华医院动物咬伤科收治的136例眼镜蛇咬伤患者为研究对象,根据眼镜蛇咬伤后肢体是否发生溃疡坏死分为溃疡组(n=85)和无溃疡组(n=51)。并从患者入院治疗后开始随访30 d,收集所有患者的临床资料,包括人口统计学资料、血常规、D-D和Lac等血生化检查结果,比较两组患者临床资料、D-D及Lac水平,采用多因素Logistic回归分析眼镜蛇咬伤导致溃疡发生的影响因素,并绘制受试者工作特征(ROC)曲线探究D-D及Lac水平对眼镜蛇咬伤溃疡坏死发生的预测价值。结果:溃疡组患者白细胞计数(WBC)、中性粒细胞计数(NEUT)、中性粒细胞/淋巴细胞比值(NLR)、Lac水平、C反应蛋白(CRP)、D-D均显著高于非溃疡组患者,差异具有统计学意义(P<0.05)。Logistic回归分析结果显示:D-D和Lac是眼镜蛇咬伤患者溃疡坏死发生的影响因素;经Spearman相关性分析,眼镜蛇咬伤患者严重程度(SSS)评分与D-D和Lac水平及中性粒细胞计数均呈正相关(P<0.05);ROC曲线分析显示,D-D和Lac对眼镜蛇咬伤患者发生溃疡坏死有一定的预测价值,且联合检测的曲线下面积明显高于D-D和Lac等的单独监测(P<0.05)。结论:D-D和Lac水平与眼镜蛇咬伤患者溃疡坏死发病风险相关,可作为溃疡坏死风险预测因子,对临床上伴有D-D和Lac升高的眼镜蛇咬伤患者,临床医护应提高警惕,加强监控,采取个体化的治疗策略,以改善不良预后。Objective:To investigate the correlation and early warning value of D-dimer(D-D)and lactic acid(Lac)on ulcer necrosis caused by cobra bite.Methods:A total of 136 patients with cobra bite admitted to hospital from May 2021 to November 2022 were selected as the research objects.According to whether the limbs of the patients expe-rienced ulcer necrosis after cobra bite,the study cohort was divided into ulcer group(n=85)and non-ulcer group(n=51).The patients were followed up for 30 days after admission.Clinical data of all patients were collected,including demographic data,blood routine,D-D,and other blood biochemical test results.Clinical data,D-D and lactate levels were compared between the two groups.Multivariate Logistic regression was used to analyze the factors influencing the occurrence of ulcer caused by cobra bite,and receiver operating(ROC)curve was drawn to explore the predictive value of D-D and lactic acid levels on the occurrence of ulcer necrosis in cobra bite.Results:The levels of white blood cell count(WBC),neutrophil count(NEUT),neutrophil lymphocyte ratio(NLR),C-reactive protein(CRP),D-D in ulcer group were significantly higher than those in non-ulcer group(P<0.05).Logistic regression analysis showed that D-D,lactic acid were the factors affecting the occurrence of ulcer necrosis in cobra bite patients.Spearman correlation analysis showed that the severity score(SSS)of cobra bite patients was positively correlated with D-D,lactate level and neutrophil ratio(P<0.05).ROC curve analysis showed that D-D and lactic acid had certain predictive value for ulcer necrosis in cobra bite patients(P<0.05).Conclusion:D-D and lactic acid are associated with the risk of ulcer necrosis in patients with cobra bite and can be used as risk predictors of ulcer necrosis.Clinical care and treatment of cobra bite patients with D-D and elevated blood lactic acid should be vigilant,strengthened monitoring,and individualized treatment strategies should be adopted to improve the poor prognosis.

关 键 词：眼镜蛇 D-二聚体 乳酸水平 溃疡坏死 预后 影响因素 

分 类 号：R646[医药卫生—外科学]