肾综合征出血热患者急性期凝血功能检测的临床意义

目的探讨血小板(platelet,PLT)、凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(actived partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)、纤维蛋白原(fibrinogen,Fib)、D-二聚体(D-dimer,DD)、纤维蛋白(原)降解产物(fibrinogen degradation product,FDP)等凝血指标对肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)患者病情严重程度和预后的预测价值。方法前瞻性纳入2016年10月-2018年7月空军军医大学第二附属医院传染科住院确诊的272例HFRS患者。依据临床分型标准,分为轻型(58例)、中型(79例)、重型(75例)和危重型组(60例)。统计患者一般资料,检测患者急性期PLT、PT、APTT、TT、Fib、DD、FDP水平。用单因素方差分析和秩和检验分析不同分组患者上述凝血指标表达的差异;用Spearman相关性分析检验PLT与PT、APTT、TT、Fib、FDP、DD之间的相关性;用ROC曲线及logistic回归方法分析上述指标对预后的预测效力。结果除轻、中型组患者外,PT在其余各组间表达差异均有统计学意义(P<0.001),PLT、APTT、TT及Fib在HFRS患者急性期各型间表达差异均有统计学意义(P<0.05);PLT与PT、APTT、TT呈显著负相关(r=-0.350、r=-0.674、r=-0.717,P<0.05),与Fib呈显著正相关(r=0.578,P<0.001);PT与Fib是预测HFRS预后(死亡)的独立影响因子(P<0.05),PT和Fib联合检测预测预后的曲线下面积(AUC)明显高于单一参数检测(P<0.001)。结论PLT、PT、APTT、TT和Fib的异常表达与HFRS疾病严重程度和预后密切相关,PT与Fib是预测患者预后的独立影响因子。

Clinical significance of coagulation function detection in patients of hemorrhagic fever with renal syndrome during the acute stage

Objective To evaluate the predictive value of platelet(PLT), prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT), fibrinogen(Fib), D-dimer(DD), fibrinogen degradation product(FDP) and other coagulation parameters on prognosis and disease severity in patients of hemorrhagic fever with renal syndrome(HFRS). Methods We prospectively included 272 patients with HFRS admitted to our center from October 2016 to July 2018.According to the clinical classification criteria, thepatients were divided into mild(n=58),moderate(n=79),severe(n=75)and critical-type(n=60)groups.The levels of PLT,PT,APTT,TT,Fib,DD and FDP during the acute stage were measured.Oneway ANOVA and rank sum test were used to analyze the difference of the levels on the coagulation parameters mentioned above among different groups,and the correlation between PLT and PT,APTT,TT,Fib,DD,and FDP was analyzed by the Spearman analysis.ROC curve and logistic regression were used to analyze the predictive effect of the parameters on prognosis. Results In addition to the mild and moderate groups,the expression of PT among other types during the acute stage in HFRS patients demonstrated statistically significant differences(P<0.001).The expression of PLT,APTT,TT and Fib during the acute stage showed significant difference(P <0.05).PLT was negatively correlated with PT,APTT and TT(r=-0.350,-0.674,-0.717,respectively,P<0.05),and positively correlated with Fib(r=0.578,P<0.001).PT and Fib were indicated as independent predictive factors of prognosis(death)of HFRS(P<0.001).The area under the curve(AUC)of the combined detection of PT and Fib demonstrated significantly higher than that of the single parameter(P<0.001). Conclusions The abnormal expressions of PLT,PT,APTT,TT and Fib were closely related with the severity and prognosis of HFRS.PT and Fib are considered as independent predictive factors of prognosis.