凝血异常在社区获得性肺炎病情评估中的应用价值

目的 通过探讨社区获得性肺炎(community-acquired pneumonia,CAP)患者凝血指标变化,揭示凝血异常在CAP病情评估方面的价值.方法 回顾性分析厦门大学附属第一医院呼吸科2010年6月至2011年5月收治的385例成人CAP患者,同期住院的146例除外感染、肿瘤、外伤、血栓性疾病等因素患者作为对照组,观察两组间凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、凝血酶时间(TTT)、血小板计数及D二聚体等凝血指标的差异.CAP患者行肺炎严重度指数(PSI)评估病情,比较不同凝血指标与PSI的相关性.结果 (1) CAP组和对照组PLT、PT、APTT、Fib、D-二聚体异常率分别为92/385和9/146,39/385和1/146,108/385和7/146,331/385和47/146,348/385和5/146,差异均具有统计学意义(x2值分别为21.608,13.557,33.747,149.280,365.619,均P＜0.01),TT异常率差异无统计学意义(8/385和0/146,x2=1.839,P＞0.05).中高危CAP患者与低危患者PLT、PT、D-二二聚体异常率分别为45/148和47/237,26/148和13/237,146/148和202/237,差异均具有统计学意义(x2值分别为5.602,14.609,23.442,均P＜0.05).TT、APTT、Fib异常率分别为6/148和2/237,47/148和61/237,123/148和208/237,差异无统计学意义(x2值分别为4.614,1.635,1.638,均P＞0.05). (2)D-二聚体测定值:CAP组(3.8±6.1)mg/L,显著高于对照组(0.3±0.1) mg/L,中高危CAP组(7.5±8.3)mg/L显著高于低危组(1.6±2.0) mg/L,差异均具有统计学意义(P＜0.01).D-二.聚体与PSI存在等级相关性(r =0.798,P＜0.001),PLT异常率与PSI无关(x2 =6.040,P＞0.05).结论 CAP患者存在凝血异常,且血浆D-二聚体显著升高,且与病情严重程度呈正相关,可作为病情评估的良好指标.

The value of application of coagulopathy in assessing patients with community-acquired pneumonia

Objective To explore and evaluate the predictive value of the coagulopathy in patients with community-acquired pneumonia (CAP).Methods A retrospective study was carried out for investigating the prothrombin time (PT),activated partial thromboplastin time (APTT),plasma fibrinogen (FIB),thrombin time (TT),plateslets (PLT),D-dimer in 385 patients with CAP and 146 patients without infection,tumor,trauma,thrombosis as controls.All the patients were admitted to the Respiratory Medical Department from June,2010 to May,2011.The results of the aforementioned biomarkers were analyzed and compared between two groups.The Pneumonia Severity Index (PSI) was calculated to evaluate the correlation between coagulopathy and PSI.Results The comparisons of the abnormal rates of PLT,PT,APTT,Fib,D-dimer between the patients with CAP and the controls were 92/385 vs.9/146,39/385 vs.1/146,108/385 vs.7/ 146,331/385 vs.47/146,348/385 vs.5/146,respectively.The differences were statistically significant (x2 =21.608,13.557,33.747,149.280,365.619,respectively,P ＜ 0.01),while difference in TT was not statistically significant (8/385 and 0/146,x2 =1.839,P ＞ 0.05).The differences in abnormal rate of PLT,PT,D-dimer between high-risk group of CAP and the low-risk group of CAP were 45/148 vs.47/237,26/148 vs.13/237,146/148vs.202/237,respectively,and the differences were statistically significant (x2 =5.602,14.609,23.442,respectively,P ＜0.05),while there were no differences in TT,APTT,FIB between two groups (6/148 vs.2/237,47/148 vs.61/237,123/148 vs.208/237,x2 =4.614,1.635,1.638,respectively,P ＞0.05).D-dimer in patients with CAP was (3.8 ±6.1) mg/L,compared with the controls (0.3 ±0.1) mg/L,and D-dimer in high-risk patients with CAP was (7.5 ±8.3) mg/L compared with the low-risk group (1.6 ±2.0) mg/L (P ＜ 0.001).Rank correlation existed between D-dimer and PSI (r =0.798,P ＜ 0.01),while there was no correlation between PLT and PSI (x2 =6.040,P ＞0.05).Conclusions The coagulopathy commonly occurs in patients with CAP.D-dimer was significantly higher in patients with CAP.D-dimer level is positively correlated with severity of CAP.D-dimer can be an ideal biomarker to assess the severity of patients with CAP.