【摘要】 目的探讨脓毒症患者抗凝治疗后凝血功能的变化,以及与预后的相关性。方法回顾性分析本院132例脓毒症患者的临床资料,所有患者确诊后均常规给予抗感染、补液、抑酸及给予器官支持治疗及抗凝治疗,记录患者入院1个月内预后情况,其中死亡组(46例)、存活组(86例),比较两组患者性别、年龄及抗凝治疗后凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)、血小板(PLT)],并进行logistic多因素回归分析,绘制凝血功能指标预测患者死亡风险的受试者工作特征曲线(ROC)曲线。结果存活组抗凝治疗后PT、APTT、TT、FIB、D-D均短于或低于死亡组,PLT高于死亡组,差异有统计学意义(P<0.05)。logistic多因素回归分析结果显示,PT、APTT、PLT是脓毒症患者死亡的独立影响因素(P<0.05)。PT预测死亡风险的曲线下面积为0.815,最佳诊断阈值为13.84s时,灵敏度为0.870,特异度为0.698。APTT预测死亡风险的曲线下面积为0.756,最佳诊断阈值为38.95s,灵敏度为0.848,特异度为0.698。PLT预测死亡风险的曲线下面积为0.826,当最佳诊断阈值为216.62×10~9,灵敏度为0.686,特异度为0.913。结论抗凝治疗后PT、APTT、PLT是脓毒症患者死亡的独立影响因素,对患者死亡风险有一定预测价值。更多还原

【Abstract】 Objective To investigate the changes of coagulation function in patients with sepsis after anticoagulant treatment and its correlation with prognosis.Methods The clinical data of 132 patients with sepsis in our hospital were analyzed retrospectively,and all the patients were given routine anti-infection,fluid replacement,acid suppression,organ support and anticoagulant treatment.The prognosis was recorded within 1 month after admission,the patients enrolled in the study were divided into the death group(46 cases)and the survival group(86 cases).The sex,age and coagulation function[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),two D-dimer(D-D),platelet count(PLT)]of the patients were compared between the two groups.Logistic multiple factor regression analysis was performed.At the same time,ROC curves for predicting the risk of death in patients by using coagulation function were drew.Results After the anticoagulant treatment,PT,APTT,TT,FIB,D-D values of the survival group were lower than the death group,and PLT was higher than the death group(P < 0.05).Logistic multivariate regression analysis showed that PT,APTT and PLT were independent factors in the mortality of sepsis patients(P<0.05).The area under the curve(AUC)of PT for predicting death risk was 0.815,when the best cut-off value was 13.84 s,the sensitivity was 0.870 and specificity was 0.698.The AUC of APTT for predicting death risk was 0.756.,when the best cut-off value was 38.95 s,the sensitivity was 0.848 and specificity was 0.698.The AUC of PLT for predicting death risk was 0.826,when the best cutoff value was216.62×10~9,the sensitivity was 0.686 and the specificity was 0.913.Conclusion After anticoagulant treatment,PT,APTT and PLT are independent prognostic factors of sepsis,and they have some predictive value for the risk of death.更多还原