入院时ISS评分、休克指数联合血清Syndecan-1、VWF对多发伤患者创伤性凝血病的预测价值研究  

Study on the Predictive Value of ISS Score, Shock Index Combined withSerum Syndecan-1 and VWF at Admission for Traumatic CoagulopathyDisease in Patients with Multiple Trauma

作　　者：钱龙杰[1] 苏文利[1] 朱文献[1] 陆景伟[1] 靖宇航 王毅鑫[1] QIAN Long-jie;SU Wen-li;ZHU Wen-xian;LU Jing-wei;JING Yu-hang;WANG Yi-xin(Department of Emergency Surgery,Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai,200333,China)

机构地区：[1]上海中医药大学附属普陀医院急诊外科,上海200333

出　　处：《现代生物医学进展》2024年第11期2079-2083,2144,共6页Progress in Modern Biomedicine

基　　金：上海市医学重点专科项目(ZK2019A13)。

摘　　要：目的:研究入院时损伤严重程度评分(ISS)、休克指数联合血清多配体蛋白聚糖-1(Syndecan-1)、血管性假血友病因子(VWF)对多发伤患者创伤性凝血病(TIC)的预测价值。方法:选取2019年1月至2022年12月在上海中医药大学附属普陀医院接受治疗的200例多发创伤患者。根据是否发生TIC分为TIC组(61例)以及非TIC(NTIC)组(139例)。对比两组入院时ISS评分、休克指数及血清Syndecan-1、VWF水平,单因素及多因素Logistic回归分析多发伤患者TIC发病的影响因素,受试者工作特征(ROC)曲线分析入院时ISS评分、休克指数及血清Syndecan-1、VWF对多发伤患者TIC发病的预测价值。结果:200例患者中,总计发生61例TIC患者,发生率是30.50%。TIC组的ISS评分、休克指数、Syndecan-1及VWF水平均较NTIC组更高(P<0.05)。多因素Logistic回归分析发现,低体温、酸中毒、格拉斯哥昏迷评分(GCS)<6分、并发重型颅脑损伤、入院时ISS评分升高、休克指数升高、血清Syndecan-1升高、VWF升高为多发伤患者TIC发病的危险因素。ROC曲线分析入院时ISS评分、休克指数及血清Syndecan-1、VWF等四指标联合应用对于TIC的预测价值最高,其中曲线下面积(AUC)为0.849、灵敏度为0.918、特异度为0.755,均较各项的单独预测效果更好。结论:多发伤患者入院时ISS评分升高、休克指数升高、血清Syndecan-1升高、VWF升高与TIC的发病有关。低体温、酸中毒、GCS<6分、并发重型颅脑损伤、入院时ISS评分升高、休克指数升高为多发伤患者TIC发病的危险因素。入院时ISS评分、休克指数联合血清Syndecan-1、VWF检测对多发伤患者TIC发病具有较高的预测价值。Objective:To study the predictive value of injury severity score(ISS),shock index combined with serum multiligand proteoglycan-1(Syndecan-1)and von Willebrand factor(VWF)at admission for traumatic coagulopathy disease(TIC)in patients with multiple trauma.Methods:200 patients with multiple trauma who were treated in Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2019 to December 2022 were selected.Patients were divided into TIC group(61 cases)and non-TIC(NTIC)group(139 cases)according to whether TIC occurred.The ISS score,shock index,serum Syndecan-1 and VWF levels at admission were compared in two groups,the influencing factors of TIC in patients with multiple trauma were analyzed by univariate and multivariate Logistic regression,the predictive value of ISS score,shock index,serum Syndecan-1 and VWF on TIC in patients with multiple trauma were analyzed by receiver operating characteristic(ROC)curve.Results:Among the 200 patients,a total of 61 patients with TIC occurred,with an incidence of 30.50%.The ISS score,shock index,Syndecan-1 and VWF levels in TIC group were higher than those in NTIC group(P<0.05).Multivariate Logistic regression analysis showed that,hypothermia,acidosis,Glasgow Coma Score(GCS)<6 points,complicated severe craniocerebral injury,increased ISS score at admission,increased shock index,increased serum Syndecan-1 and increased VWF were risk factors for TIC in patients with multiple trauma.ROC curve analysis showed that the combined application of ISS score,shock index,serum Syndecan-1 and VWF had the highest predictive value for TIC at admission,the area under the curve(AUC)was 0.849,the sensitivity was 0.918 and the specificity was 0.755,all of which were better than the individual prediction.Conclusion:The increase of ISS score,shock index,serum Syndecan-1 and VWF at admission are relate to the incidence of TIC in patients with multiple trauma.Hypothermia,acidosis,GCS<6 points,complicated severe craniocerebral injury,increase ISS score at admissi

关 键 词：损伤严重程度评分 休克指数 SYNDECAN-1 VWF 多发伤 创伤性凝血病 预测价值 

分 类 号：R605.971[医药卫生—急诊医学] R641[医药卫生—外科学]