目的 探讨预防性抗凝治疗对重症新型冠状病毒肺炎（COVID-19）患者28 d预后的价值。 方法 收集2022年12月至2023年1月广东省人民医院的重型/危重型COVID-19患者的病例资料，包括年龄、性别、既往史、血常规、肝肾指标、凝血指标、Padua评分、抗病毒治疗、激素治疗、免疫治疗、抗凝治疗等，分为非抗凝组和抗凝组，采用非参数检验比较组间差异，COX回归评价28 d预后的独立死亡风险因素，及亚组间的抗凝疗效。 结果 158例患者分为非抗凝组30例和抗凝组128例。（1）两组间在高血压例数、危重型例数、淋巴细胞计数、凝血酶原时间、D-二聚体、免疫治疗例数存在统计学差异（均P < 0.05），其余指标无差异。（2）多因素COX回归显示抗凝治疗（HR = 2.25，95%CI：1.01 ~ 5.01，P = 0.048）是患者28 d病死的独立风险因素。（3）亚组分析显示降钙素原≥ 0.5 pg/mL（HR = 2.72，95%CI：1.05 ~ 7.04）或D-二聚体< 2 000 ng/mL（HR = 9.16，95%CI：1.63 ~ 51.48），抗凝治疗增加患者28 d病死风险（均P < 0.05）。 结论 重症COVID-19患者进行预防性抗凝治疗不能降低28 d全因死亡风险。

Objective To explore the value of prophylactic anticoagulation in the 28?day prognosis of patients with severe COVID?19. Methods The clinical data of COVID?19 patients admitted to Guangdong Provincial People's Hospital from December 2022 to January 2023 were collected， including age， gender， past medical history， routine blood test， liver and renal function， procalcitonin， coagulation function， Padua prediction score， antiviral therapy， hormonotherapy， immunotherapy and anticoagulation therapy. The patients were divided into an anticoagulation group and a non?anticoagulation group. The differences in various indicators were compared between the two groups. Cox regression was performed to assess the independent risk factors for 28?day mortality and the anticoagulation efficacy between the subgroups. Results Among 158 patients， 128 received anticoagulation； There were significant differences between the two groups in case number of hypertension and critical condition， lymphocyte count， prothrombin time， D?dimer， and case number of immunotherapy. COX logistic regression showed that anticoagulation （HR = 2.25， 95%CI： 1.01 ~ 5.01， P = 0.048） was an independent risk factor for all?cause mortality of COVID?19 patients within 28 days. Subgroup analysis showed that anticoagulation therapy led to an increase in the 28?day mortality as level of procalcitonin of ≥ 0.5 pg/mL （HR = 2.72， 95%CI： 1.05 ~ 7.04） or D?dimer of < 2 000 ng/mL （HR = 9.16， 95%CI： 1.63 ~ 51.48）. Conclusions Prophylactic anticoagulation did not reduce all?cause mortality of COVID?19 within 28 days.