纤维蛋白原与白蛋白比值联合血小板预测成人静脉-动脉体外膜肺氧合血栓栓塞并发症  

Fibrinogen-to-albumin ratio combined with platelets in prediction of thromboembolic complications during veno-venous arteriovenous extracorporeal membrane oxygenation in adults

作　　者：王玥琦 刘小军[1] 陈春艳[1] 秦绍杰 丁会杰 WANG Yueqi;LIU Xiaojun;CHEN Chunyan;QIN Shaojie;DING Huijie(Department of Intensive Care Medicine,The Second Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450003,China)

机构地区：[1]郑州大学第二附属医院重症医学科,河南郑州450003

出　　处：《中国临床研究》2025年第2期205-210,共6页Chinese Journal of Clinical Research

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220462)。

摘　　要：目的研究纤维蛋白原与白蛋白比值(FAR)联合血小板预测静脉-动脉体外膜肺氧合(VA-ECMO)上机期间血栓栓塞并发症的价值。方法回顾性收集2020年至2023年郑州大学第二附属医院重症医学科收治的使用VA-ECMO治疗的130例患者的临床资料。运用logistic回归分析探索血栓栓塞并发症的危险因素,使用受试者工作特征(ROC)曲线和曲线下面积(AUC)分析FAR联合血小板的预测血栓栓塞并发症的能力。结果共纳入130例患者,其中男性87例,女性43例,年龄(52.2±15.3)岁,全部接受VA-ECMO治疗。出现血栓栓塞的患者33例,与未出现血栓栓塞的患者相比,上机第1天纤维蛋白原、FAR水平较高(P<0.05);上机第1天、第3天血小板和上机后白蛋白水平较低(P<0.05)。多因素logistic回归分析显示,上机第1天FAR与血栓栓塞独立相关(P<0.05),AUC为0.690(95%CI:0.569~0.810)。上机第1天血小板与血栓栓塞独立相关(P<0.05),AUC为0.664(95%CI:0.558~0.771)。两者联合预测血栓栓塞并发症的AUC为0.794(95%CI:0.703~0.885),预测价值最高。结论上机第1天FAR联合血小板可以用于预测VA-ECMO支持期间血栓栓塞并发症的发生。Objective To investigate the value of the fibrinogen-to-albumin ratio(FAR)combined with platelet count in predicting thromboembolic complications during venous-arterial extracorporeal membrane oxygenation(VA-ECMO).Methods Clinical data from 130 patients who received VA-ECMO therapy in the Intensive Care Unit of The Second Affiliated Hospital of Zhengzhou University from 2020 to 2023 were retrospectively collected.Logistic regression analysis was used to identify risk factors for thromboembolic complications.Receiver operating characteristic(ROC)curves and area under the curve(AUC)were used to evaluate the predictive ability of FAR combined with platelet count for thromboembolic complications.Results A total of 130 patients were included,of which 87 were male and 43 were female,with an age of(52.2±15.3)years.All patients received VA-ECMO treatment.Thirty-three patients developed thromboembolic complications.Compared to patients without thromboembolic complications,those who developed complications had higher fibrinogen and FAR levels on Day 1 of VA-ECMO(P<0.05)and lower platelet count and albumin levels after VA-ECMO initiation,and on Days 1 and 3(P<0.05).According to multivariate logistic regression,FAR on Day 1 was independently associated with thromboembolic complications(P<0.05),with an AUC of 0.690(95%CI:0.569-0.810).Platelet count on Day 1 was also independently associated with thromboembolic complications(P<0.05),with an AUC of 0.664(95%CI:0.558-0.771).The combined prediction of thromboembolic complications using both FAR and platelet count resulted in the highest predictive value,with an AUC of 0.794(95%CI:0.703-0.885).Conclusion The combination of FAR and platelet count on Day 1 of VA-ECMO can be used to predict the occurrence of thromboembolic complications during VA-ECMO support.

关 键 词：静脉-动脉体外膜肺氧合 血栓栓塞 并发症 纤维蛋白原 白蛋白 血小板 

分 类 号：R364.15[医药卫生—病理学]