劳力性中暑血小板减少的危险因素分析  

Analysis of risk factors for thrombocytopenia in exertional heat illness

作　　者：胡冰琴 宋景春[1] 何龙平 黄雨 周叶 刘嘉玲 齐英含 吴阳 Hu Bingqin;Song Jingchun;He Longping;Huang Yu;Zhou Ye;Liu Jialing;Qi Yinghan;Wu Yang(Department of Critical Care Medicine,the 908th Hospital of the Joint Logistic Support Force of Chinese PLA/Department of Critical Care Medicine,Nanchang University Affiliated Great Wall Hospital,Nanchang 330002,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇八医院重症医学科/南昌大学附属长城医院重症医学科,南昌330002

出　　处：《血栓与止血学》2025年第1期8-13,共6页Chinese Journal of Thrombosis and Hemostasis

基　　金：江西省卫健委科技计划(SKJP_202131123)。

摘　　要：目的探索影响劳力性中暑患者血小板减少的危险因素。方法回顾性分析2022年03月至2022年09月中国24家医院收治的266例中暑患者的临床资料,根据是否发生血小板减少分为PLT≥150×10^(9)/L组(n=198)和PLT<150×10^(9)/L组(n=68)。收集两组患者入科2 h内的基础资料、血常规、血生化及常规凝血指标等,并进行统计学分析。结果与PLT≥150×10^(9)/L组患者核心温度[37.0(36.6~37.5)℃]相比,PLT<150×10^(9)/L组患者核心温度[39.6(38.8~40.5)℃]明显升高(P<0.001)。随机森林分析和多因素Logistic回归分析显示核心温度是劳力性中暑血小板减少的独立危险因素。ROC曲线分析显示核心温度>39.0℃时,预测血小板减少的曲线下面积为0.818(95%CI:0.749~0.888,P<0.001),敏感度为67.6%,特异度为87.9%。结论核心温度>39.0℃是劳力性中暑患者发生血小板减少的独立危险因素。Objective To explore the risk factors affecting the decrease of platelets in patients with exertional heatstroke.Methods A retrospective analysis was conducted on the clinical data of 266 heatstroke patients admitted to 24 hospitals in China from March 2022 to May 2022.Patients were divided into two groups based on the occurrence of thrombocytopenia:PLT≥150×10^(9)/L group(n=198)and PLT<150×10^(9)/L group(n=68).Basic information,blood routine test results,blood biochemistry,and routine coagulation indicators within 2 hours of admission were collected and statistically analyzed.Results Compared to the PLT≥150×10^(9)/L group,patients in the PLT<150×10^(9)/L group exhibited significantly elevated core body temperature[39.6℃(38.8-40.5℃)vs.37.0℃(36.6-37.5℃)],alanine aminotransferase[41.2 U/L(19.0-203.6 U/L)vs.22.0 U/L(17.4-35.8 U/L)],aspartate aminotransferase[44.6 U/L(20.0-188.0 U/L)vs.27.0 U/L(20.0-41.1 U/L)],total bilirubin[17.2 mmol/L(11.6-24.2 mmol/L)vs.13.0 mmol/L(8.6-18.4 mmol/L)],serum creatinine[90.0μmol/L(73.3-135.5μmol/L)vs.82.0μmol/L(67.0-98.0μmol/L)],creatine kinase[529.5 U/L(110.0-1805.0 U/L)vs.252.0 U/L(117.5-541.0 U/L)],and D-dimer levels[1.1 mg/L(0.2-3.8 mg/L)vs.0.3 mg/L(0.1-0.6 mg/L)].Additionally,the PLT<150×10^(9)/L group demonstrated a significantly faster heart rate[92 beats/min(71-109 beats/min)vs.75 beats/min(68-85 beats/min)]and prolonged coagulation times,including prothrombin time[14.1 s(12.5-18.6 s)vs.13.0 s(12.1-14.0 s)]and activated partial thromboplastin time[32.9 s(29.2-40.7 s)vs.29.5 s(26.8-32.4 s)](all P<0.05).The Random Forest algorithm analysis and multivariate Logistic regression analysis found that core temperature is an independent risk factor for the decrease of platelets in exertional heatstroke.ROC curve analysis showed that when core temperature>39.0℃,the area under the curve for predicting thrombocytopenia was 0.818(95%CI:0.749-0.888,P<0.001),with a sensitivity of 67.6%and specificity of 87.9%.Conclusion Core temperature>39.0℃is a major risk factor fo

关 键 词：劳力性中暑 血小板 核心温度 危险因素 

分 类 号：R594.12[医药卫生—内科学]