COVID-19患者血浆凝血指标及D-二聚体水平检测对临床分型的鉴别价值

目的　探讨新型冠状病毒肺炎(COVID-19)患者疾病分型中血浆凝血指标及D-二聚体的鉴别价值。方法 　选取2020年1月25日～2月24日在荆州市中心医院诊断为COVID-19的52例患者住院期间检查的101份血凝标本，将样本按采血时患者的疾病分期分为轻症（n=31）和重症（n=70）。应用非配对t检验和受试者工作曲线（ROC 曲线）分析探讨凝血指标以及D-二聚体水平与患者疾病严重程度的关系，其中凝血指标包括活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、凝血酶原时间（PT）和血浆纤维蛋白原（Fg）。结果　101份血凝标本中，重症组凝血指标中的APTT，TT和PT以及D-二聚体水平显著高于轻症组，差异均具有统计学意义（P<0.05）。而Fg含量差异无统计学意义（P>0.05）。APTT，TT，PT，D-二聚体，APTT+TT，APTT+PT和TT+PT的ROC曲线下面积（AUC）分别为0.605，0.749，0.760，0.949，0.764，0.758和0.865。结论　单独D-二聚体、凝血指标联合使用对COVID-19疾病分型有很好的诊断价值，可辅助临床诊疗，进一步推广于临床。

Preliminary Study on the Differential Value of Coagulation Indexes and D-dimer Level in the Clinical Classification of COVID-19 Patient

Objective To explore the differential value of plasma coagulation indexes and D-dimer in the disease classification of patients with novel coronavirus pneumonia(COVID-19).Methods From January 25 to February 24,2020,101 blood coagulation specimens from 52 patients diagnosed with COVID-19 in Jingzhou Central Hospital were selected.The samples were divided into mild(n=31)and severe(n=31)according to the disease stage of the patients at the time of blood collection.Unpaired t test and receiver operating curve(ROC curve)analysis were used to analysis explore relationship between coagulation indicators and the level of D-dimer and the severity of the patient’s disease,where in the coagulation indicators comprise activated partial thromboplastin time(APTT),thrombin time(TT),prothrombin time(PT)and plasma fibrinogen(Fg).Results Among 101 blood coagulation specimens,the levels of APTT,TT,PT and D-dimer in the coagulation index of the severe group were significantly higher than those of the mild group(P<0.05),the difference was statistically significant,but the Fg content was not statistically significant(P>0.05).The area under the ROC curve(AUC)of APTT,TT,PT,D-dimer,APTT+TT,APTT+PT and TT+PT were 0.605,0.749,0.760,0.949,0.764,0.758 and 0.865 respectively.Conclusion The use of D-dimer alone and combined use of coagulation indicators have a good diagnostic value for COVID-19 disease classification.It can assist clinical diagnosis and treatment,and be further promoted in clinical practice.