低钙血症在脓毒症性凝血病早期诊断中的效价研究  

Titer study of hypocalcemia in early identification of sepsis-induced coagulopathy

作　　者：李晨 杨爱祥[1] 刘军[1] LI Chen;YANG Aixiang;LIU Jun(Department of Critical Care Medicine,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215001,Jiangsu,China)

机构地区：[1]南京医科大学附属苏州医院重症医学科,江苏苏州215001

出　　处：《中国现代医生》2025年第12期36-39,共4页China Modern Doctor

摘　　要：目的研究低钙血症在脓毒症性凝血病(sepsis-induced coagulopathy,SIC)早期诊断中的评估价值。方法回顾性分析2023年4月至2024年4月南京医科大学附属苏州医院重症医学科76例脓毒症患者的临床资料,并分为SIC组(n=36)和非SIC组(n=40)。收集患者的性别、年龄、感染部位、基础性疾病及脓毒症相关性器官功能衰竭评价(sepsis-related organ failure assessment,SOFA)评分。入院首次检查动脉血气分析、静脉血生化、纤维蛋白原、炎症指标[降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)]、重症医学科入住时间和机械通气时间。采用多因素Logistic回归分析和受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评价血钙水平对SIC的预测价值。结果SIC组患者的年龄高于非SIC组,差异有统计学意义(P<0.05)。SIC组患者的离子钙水平明显低于非SIC组(P<0.05);SIC组患者的炎症指标PCT、CRP明显高于非SIC组(P<0.01),多因素Logistics回归分析提示低钙血症是SIC的独立危险因素(OR=3.431,95%CI:1.032~11.409)。离子钙与SIC发生相关性的ROC曲线下面积为0.665(95%CI:0.543~0.788),截断值为1.03mmol/L。结论低钙血症是发生SIC的独立危险因素,积极纠正早期低钙血症有助于改善SIC患者的临床预后。Objective To investigate the value of hypocalcemia in early diagnosis of sepsis-induced coagulopathy(SIC).Methods Clinical data of 76 patients with sepsis in Department of Critical Care Medicine,the Affiliated Suzhou Hospital of Nanjing Medical University from April 2023 to April 2024 were retrospectively analyzed,patients were divided into SIC group(n=36)and non-SIC group(n=40),including age,sex,site of infection,underlying disease,sepsis-related organ failure assessment(SOFA)were collected.Arterial blood gas analysis,venous blood biochemistry,fibrinogen,inflammatory indicators procalcitonin(PCT),C-reactive protein(CRP),length of stay in Department of Critical Care Medicine,and mechanical ventilation time.Multivariate Logistic regression analysis and receiver operating characteristic(ROC)curve were used to evaluate the predictive value of serum calcium level in SIC.Results The age of patients in SIC group was significantly higher than that of non-SIC group(P<0.05).The level of ionic calcium in SIC group was significantly lower than that in non-SIC group(P<0.05).Inflammatory indicators PCT and CRP in SIC group were significantly higher than those in non-SIC group(P<0.01).Multivariate logistic regression analysis showed that hypocalcemia was an independent risk factor for SIC(OR=3.431,95%CI:1.032-11.409).The area under ROC curve of the correlation between ionic calcium and SIC was 0.665(95%CI:0.543-0.788),and the best cut-off value was 1.03mmol/L.Conclusion Hypocalcemia is an independent risk factor for SIC.Active correction of early hypocalcemia is helpful to improve the clinical prognosis with SIC.

关 键 词：脓毒症 脓毒症性凝血病 低钙血症 

分 类 号：R459.7[医药卫生—急诊医学] R659[医药卫生—治疗学]