摘要
目的:探讨血小板最大聚集率(MAR)对脓毒性休克及脓毒性休克合并弥散性血管内凝血(DIC)的预测价值。方法:采用回顾性病例对照研究,针对2021年1月至2022年11月郑州大学第一附属医院重症医学科收治的脓毒症患者,收集其基本资料及入院24 h内的动态MAR、血常规、炎症指标、序贯器官衰竭评分(SOFA)等指标。根据有无脓毒性休克将脓毒症患者分为休克组和非休克组;再参照国际血栓与止血学会(ISTH)标准,根据有无显性DIC将脓毒性休克患者分为休克DIC组和休克非DIC组。比较各组间血小板聚集功能有无差异,绘制受试者工作特征曲线(ROC曲线)评价MAR对脓毒性休克及脓毒性休克合并DIC的预测价值。采用Spearman相关法分析脓毒症患者MAR与炎症指标及病情严重程度的相关性。结果:共纳入153例脓毒症患者,其中脓毒性休克患者61例(包括有显性DIC者17例和无显性DIC者44例)。与非休克组患者比较,休克组患者降钙素原(PCT)、C-反应蛋白(CRP)及SOFA评分均明显升高〔PCT(mg/L):6.90(2.50,23.50)比0.87(0.26,5.75),CRP(mg/L):156.48(67.11,230.84)比90.39(46.43,182.76),SOFA评分(分):11.00(8.00,14.00)比5.00(3.00,8.00),均 P<0.05〕,同时血小板计数(PLT)及分别以二磷酸腺苷(ADP)、肾上腺素(A)、胶原(COL)、花生四烯酸(AA)为诱导剂的MAR(ADP-MAR、A-MAR、COL-MAR、AA-MAR)均明显降低〔PLT(×10 9/L):101.00(49.00,163.50)比175.50(108.25,254.50),ADP-MAR:28.50%(22.00%,38.05%)比45.90%(33.98%,60.28%),A-MAR:38.90%(30.00%,55.40%)比65.15%(54.38%,72.53%),COL-MAR:27.90%(20.85%,36.55%)比42.95%(33.73%,54.08%),AA-MAR:24.70%(16.40%,34.20%)比46.55%(28.33%,59.20%),均 P<0.05〕。亚组分析显示,与休克非DIC组比较,休克DIC组患者SOFA评分明显升高(分:13.29±5.23比10.39±3.58, P<0.05),PLT和COL-MAR明显降低〔PLT(×10^(9)/L):36.00(22.00,67.50)比115.50(84.25,203.75),COL-MAR:21.50%(17.85%,32.60%)比30.95%(22.98%,38.53%),均 P<0.05〕。ROC曲线分析显示,A-MAR�
Objective To investigate the predictive value of the maximum aggregation rate(MAR)of platelet for septic shock and septic shock with disseminated intravascular coagulation(DIC).Methods A retrospective case-control study enrolled patients with sepsis admitted to department of critical care medicine of the First Affiliated Hospital of Zhengzhou University from January 2021 to November 2022.The basic data,dynamic platelet aggregation rate,blood routine,inflammation indicators,sequential organ failure assessment(SOFA)and other clinical indicators within 24 hours after admission were collected.Septic patients were divided into the shock group and the non-shock group according to the presence of septic shock;then refer to the International Society on Thrombosis and Hemostasis(ISTH)standard,patients with septic shock were divided into the shock DIC group and the shock non-DIC group according to the presence of dominant DIC.Compared the differences in platelet aggregation function between these groups,and the receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of the MAR for septic shock and septic shock with DIC.Spearman correlation analysis was used to analyze the correlation of MAR with inflammation indicators and the severity of illness in patients with sepsis.Results A total of 153 sepsis patients were included and 61 with septic shock(including 17 with dominant DIC and 44 without dominant DIC).Compared with the non-shock group,the level of procalcitonin(PCT),C-reactive protein(CRP),and SOFA score were significantly higher in the shock group[PCT(mg/L):6.90(2.50,23.50)vs.0.87(0.26,5.75),CRP(mg/L):156.48(67.11,230.84)vs.90.39(46.43,182.76),SOFA score:11.00(8.00,14.00)vs.5.00(3.00,8.00),all P<0.05].The platelet count(PLT)and the MAR induced by adenosine diphosphate(ADP),adrenaline(A),collagen(COL),and arachidonic acid(AA;ADP-MAR,A-MAR,COL-MAR,AA-MAR)in the shock group were significantly decreased[PLT(×10^(9)/L):101.00(49.00,163.50)vs.175.50(108.25,254.50),ADP-MAR:28.50%(22.00%,3
作者
崔秋敏
孙小鸽
马宁
刘启龙
杨宏富
孙荣青
Cui Qiumin;Sun Xiaoge;Ma Ning;Liu Qilong;Yang Hongfu;Sun Rongqing(Department of Critical Care Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450018,Henan,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2023年第3期238-243,共6页
Chinese Critical Care Medicine
基金
河南省医学科技攻关计划(联合共建)项目(LHGJ20190213)
河南省医学教育研究项目(Wjlx2020392)。
关键词
脓毒症
脓毒性休克
弥散性血管内凝血
血小板最大聚集率
Sepsis
Septic shock
Disseminated intravascular coagulation
Maximum aggregation of platelet
