活化凝血时间、纤维蛋白凝结速率联合APACHEⅡ评分对脓毒症患者28天预后的评估价值  

Evaluation of Activated Coagulation Time,Fibrin Coagulation Rate Combined with APACHEⅡScore in 28-day Prognosis of Patients with Sepsis

作　　者：王晶[1] 郭涛[1] 杨婷雯 谭宇卫 WANG Jing;GUO Tao;YANG Tingwen;TAN Yuwei(Department of Emergency,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院,南京210029

出　　处：《微循环学杂志》2025年第1期16-20,共5页Chinese Journal of Microcirculation

基　　金：江苏省中医药科技发展计划项目(MS2022018)。

摘　　要：目的:分析活化凝血时间(ACT)、纤维蛋白凝结速率(CR)等凝血纤溶指标及急性生理与慢性健康评分(APACHEⅡ)评估脓毒症患者28天预后的临床价值。方法:选取2022-10-2024-02本院急诊科127例脓毒症住院患者,根据入院后28天生存情况分为存活组(n=92)和死亡组(n=35),比较两组入院时一般资料和实验室指标[降钙素原(PCT)、C-反应蛋白(CRP)、白细胞计数(WBC)、淋巴细胞计数(Lym)、血红蛋白浓度(Hb)、血小板计数(PLT)]和凝血纤溶指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、D-二聚体(D-D)]、ACT、CR水平及APACHEⅡ评分。Pearson相关法分析APACHEⅡ评分与ACT、CR、PCT、CRP、Lym、APTT、D-D水平的相关性。Logistic回归分析脓毒症患者不良预后的独立危险因素。受试者工作特征(ROC)曲线分析以上危险因素单独或联合评估患者预后的临床价值。结果:相较于存活组,死亡组APACHEⅡ评分PCT、CRP、ACT、APTT、D-D水平更高,而CR、Lym水平更低(均P<0.05或P<0.01);相关法分析显示,死亡组APACHEⅡ评分与PCT、CRP、ACT、APTT、D-D水平呈正相关,而与Lym、CR水平呈负相关(均P<0.05或P<0.01);Logistic回归结果,ACT≥152.38s、CR≤24.84mm/min、APTT≥45.80s、APACHEⅡ评分≥21.80分是脓毒症患者不良预后的独立危险因素。ROC显示,APTT评估患者预后的曲线下面积(AUC)为0.582;ACT、CR及APACHEⅡ评分的AUC分别为0.850、0.886、0.808,后三者联合评估患者预后的AUC为0.946。结论:ACT、CR及APACHEⅡ评分联合评估脓毒症患者28天预后有较高临床价值。Objective:To analyze the clinical value of activated coagulation time(ACT),fibrin clotting(CR),and other coagulation and fibrinolysis indicators,as well as the acute physiology and chronic health evaluation(APACHE II)score,in predicting the 28-day prognosis of sepsis patients.Method:A total of 127 sepsis inpatients in the emergency department from October 2022 to February 2024 were selected.According to the survival status within 28 days after admission,the patients were divided into a survival group(n=92)and a death group(n=35).The general information and laboratory indicators[PCT,C-reactive protein(CRP),white blood cell count(WBC),lymphocyte count(Lym),hemoglobin concentration(Hb),platelet count(PLT)]and coagulation and fibrinolysis indicators[prothrombin time(PT),activated partial thromboplastin time(APTT),throm time(TT),D-dimer(D-D)],ACT,CR levels,and APACHE II scores at admission were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between APACHE II scores and ACT,CR,PCT,CRP,Lym,APTT,and D-D levels.Regression analysis was used to identify the independent risk factors for poor prognosis in sepsis patients.Receiver operating characteristic(ROC)curves were used to analyze the clinical value the above risk factors in predicting patient prognosis alone or in combination.Results:Compared with the survival group,the death group had higher levels of APACHE II scores,CT,CRP,ACT,APTT,and D-D,and lower levels of CR and Lym(all P<0.05 or P<0.01).Correlation analysis showed that the APACHE II scores in the death group were positively correlated with PCT,CRP,ACT,APTT and D-D levels,and negatively correlated with Lym and CR levels(all P<0.05 or P<0.01).The results of Logistic showed that ACT≥152.38 s,CR≤24.84 mm/min,APTT≥45.80,and APACHE II score≥21.80 were independent risk factors for poor prognosis in sepsis patients.ROC showed that the area under curve(AUC)for APTT in predicting patient prognosis was 0.582;the AUCs for ACT,CR,and APACHE score were 0.850,0.886,and

关 键 词：活化凝血时间 纤维蛋白凝结速率 急性生理与慢性健康评分 脓毒症 

分 类 号：R459.7[医药卫生—急诊医学]