D-二聚体、乳酸联合可溶性血小板内皮黏附分子-1对脓毒症相关弥散性血管内凝血患者预后不良的预测研究
收稿日期: 2023-05-28
网络出版日期: 2023-10-10
基金资助
徐州市科学技术项目(KC17172);徐州医科大学附属医院院课题项目(2021ZA33)
D⁃dimer and lactic acid combined with sPECAM⁃1 in the prediction of poor prognosis in patients with sepsis⁃related disseminated intravascular coagulation
Received date: 2023-05-28
Online published: 2023-10-10
目的 探讨D-二聚体（D-D）、乳酸（Lac）和可溶性血小板内皮黏附分子-1（sPECAM-1）在预测脓毒症相关弥散性血管内凝血（DIC）预后中的价值。 方法 收集2017年1月至2022年1月徐州医科大学附属医院ICU脓毒症相关DIC患者300例，按照预后情况分为死亡和存活两组。对比两组患者一般资料、APACHE Ⅱ评分、血清D-D、乳酸、sPECAM-1水平，采用Logistic回归分析筛选脓毒症相关DIC患者28 d死亡的危险因素，并采用受试者工作特征曲线（ROC）评价血清 D-D、乳酸、sPECAM-1对脓毒症相关DIC患者预后不良的预测价值。 结果 患者28 d病死率为22%，死亡组患者 APACHE Ⅱ评分、血清 D-D、Lac和sPECAM-1水平均高于存活组（P < 0.05）；多因素logistic回归结果显示，血清D-D、乳酸、sPECAM-1是脓毒症相关DIC患者28 d死亡的危险因素；血清D-D、乳酸、sPECAM-1预测脓毒症相关DIC患者预后的ROC下AUC分别为0.863（95% CI：0.768 ~ 0.958）、0.831（95% CI：0.734 ~ 0.928）、0.774（95% CI：0.653 ~ 0.896），三项指标联合预测的ROC下AUC是0.965（95% CI：0.928 ~ 1.000），敏感度是0.864，特异度是0.974，较各指标单独预测高。 结论 较高的血清D-D、乳酸、sPECAM-1水平与脓毒症相关DIC患者28 d死亡密切相关，血清D-D、乳酸联合sPECAM-1对脓毒症相关DIC预后有较好的预测价值，可用于指导临床治疗。
关键词： 脓毒症; 弥散性血管内凝血; D-二聚体; 乳酸; 可溶性血小板内皮黏附分子-1
王子文 , 赵文静 , 晁亚丽 . D-二聚体、乳酸联合可溶性血小板内皮黏附分子-1对脓毒症相关弥散性血管内凝血患者预后不良的预测研究[J]. 实用医学杂志, 2023 , 39(18) : 2379 -2383 . DOI: 10.3969/j.issn.1006-5725.2023.18.016
Objective To investigate the predictive value of D?dimer （D?D）， lactic acid， and soluble platelet endothelial adhesion molecule?1 （sPECAM?1） in patients with sepsis?associated disseminated intravascular coagulation （DIC）. Methods According to the prognosis of patients at 28 days， 300 patients with sepsis?related DIC in the ICU of the Affiliated Hospital of Xuzhou Medical University were gathered and split into death and survival groups. The two groups' general statistics， APACHEⅡ score， serum D?D， lactate， and sPECAM?1 levels were compared. The operating characteristic curve （ROC） was used to evaluate the predictive value of serum D?D， lactate， and sPECAM?1 on the poor prognosis of patients with sepsis?related DIC. Results The 28?day mortality rate of patients with sepsis?related DIC was 22%， and the death group had higher APACHEⅡ scores， serum D?D， lactate， and sPECAM?1 levels than the survival group （P < 0.05）. Multivariate logistic regression results showed that serum D?D， lactic acid and sPECAM?1 were risk factors for 28?day death in patients with sepsis?related DIC.The AUC of serum D?D， lactic acid， and sPECAM?1 was 0.863 （95%CI： 0.768 ~ 0.958）， 0.831 （95%CI： 0.734 ~ 0.928）， 0.774 （95%CI： 0.653 ~ 0.896）， respectively. The AUC of the combination of serum D?D， lactic acid and sPECAM?1 was 0.965 （95%CI： 0.928 ~ 1.000）， with the sensitivity 0.864 and the specificity 0.974， each of which were greater than the individual predictions. Conclusion In patients with sepsis?related DIC， higher serum D?D， lactate， and sPECAM?1 levels were highly correlated with 28?day death.In patients with sepsis?related DIC， higher serum D?D， lactate， and sPECAM?1 levels were highly correlated with 28?day death. The combination of serum D?D， lactate， and sPECAM?1 levels provided a high predictive value for the prognosis of sepsis?related DIC and might be employed in therapeutic treatment.
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