凝血功能异常对发热伴血小板减少综合征预后及出血的评估价值

    The value of coagulation dysfunction in evaluating the prognosis and hemorrhage of severe fever complicated with thrombocytopenia syndrome

    • 摘要:
      目的: 探讨发热伴血小板减少综合征(SFTS)病人凝血功能异常对预后的影响,并评估其与出血事件的关系。
      方法: 回顾性分析43例SFTS病人的临床资料和实验室检查指标,比较生存组和死亡组病人的基线特征和实验室指标差异,采用多因素logistic回归分析筛选预后相关危险因素,绘制ROC曲线评估相关指标的预测价值。
      结果: 死亡组病人的意识障碍比例、出血事件比例、天门氨酸转移酶、γ-谷氨酰基转移酶、肌酐(Cr)、肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶、C反应蛋白、凝血酶原时间、凝血酶时间(TT)、活化部分凝血活酶时间、国际标准化比值、D-二聚体水平均高于生存组(P < 0.05 ~ P < 0.01),而血小板计数、血钙、纤维蛋白原水平均低于生存组(P < 0.05);logistic回归分析显示,TT和Cr水平升高是SFTS死亡的独立危险因素(P < 0.05)。ROC分析显示,TT单独预测SFTS病人的死亡结局的AUC为0.771,而TT联合Cr的AUC为0.846;凝血指标中D-二聚体预测SFTS病人出血事件的效能最佳,AUC为0.796。
      结论: SFTS病人凝血功能异常与预后和出血事件的发生密切相关,TT和Cr可作为评估预后的临床指标。凝血指标异常,尤其是D-二聚体升高较血小板计数下降对出血事件的预测更有帮助。

       

      Abstract:
      Objective To explore the impact of abnormal coagulation function on prognosis in patients with fever complicated with thrombocytopenia syndrome (SFTS), and evaluate its relationship with bleeding events.
      Methods The clinical data and laboratory test indicators of 43 patients with SFTS were retrospectively analyzed. The baseline characteristics and laboratory indicators differences between the survival group and death group were compared. Multivariate logistic regression analysis was used to screen for prognostic risk factors, and the ROC curve was plotted to evaluate the predictive value of related indicators.
      Results The proportions of consciousness disorders and bleeding events, levels of tyrosine transferase, γ -glutamyl transferase, creatinine (Cr), creatine kinase, creatine kinase isoenzyme, lactate dehydrogenase and C-reactive protein, prothrombin time, thrombin time (TT), activated partial thromboplastin time, international normalized ratio and D-dimer levels in the death group were higher than those in survival group (P < 0.05 to P < 0.01), while the average platelet count, and levels of blood calcium and fibrinogen water were lower than those in survival group (P < 0.05). The results of logistic regression analysis showed that the levels of TT and Cr increasing were the independent risk factors of death in SFTS (P < 0.05). The results of ROC analysis showed that the AUC of TT alone in predicting the mortality outcome of patients with SFTS was 0.771, while the AUC of TT combined with Cr was 0.846. Among the coagulation indicators, D-dimer has the best efficacy in predicting bleeding events in patients with SFTS, with an AUC of 0.796.
      Conclusions Abnormal coagulation function in patients with SFTS is closely related to the prognosis and occurrence of bleeding events. TT and Cr can be used as clinical indicators for evaluating prognosis. Among abnormal coagulation indicators, especially the D-dimer increasing is more helpful in predicting bleeding events than platelet count decreasing.

       

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