【摘要】 目的:由于疾病因素和治疗相关因素，血液病患者大多免疫功能低下，合并重症感染的风险增加，且重症感染凝血异常患者住院死亡率明显高于无凝血异常的患者。回顾性分析重症感染凝血异常的血液病患者的临床资料，探讨不同预后组之间指标的差异，旨在为临床上识别预后不良的患者提供依据和参考。方法:收集华中科技大学同济医学院附属协和医院血液重症病房2024年10月1日—2025年4月30日收治的50例重症感染凝血异常的血液病患者临床资料。根据患者感染控制情况及凝血功能恢复情况，分为好转组(n=13)和预后不良组(n=37)。比较两组患者住院期间的一般资料和感染指标、血常规、血生化及凝血功能指标的差异。结果:两组间性别、年龄、C反应蛋白、血清降钙素原、总胆红素水平、活化部分凝血酶时间、纤维蛋白原、D-二聚体、纤维蛋白降解产物、抗凝血酶Ⅲ活性(AT-Ⅲ)、血小板计数(PLT)比较差异无统计学意义(P>0.05)。与好转组比较，预后不良组肌酐水平、凝血酶原时间(PT)、国际标准化比值(INR)、凝血酶时间(TT)显著升高，凝血酶原活动度(PTA)显著降低，差异有统计学意义(P<0.05)。两组间粒细胞缺乏、PLT不同程度减少、PLT 24 h下降>50%、肝功能不全以及心律失常的患者占比差异无统计学意义(P>0.05)。患者原发病多为血液系统恶性肿瘤，预后不良组原发病复发/难治/高危/未缓解高于好转组，但差异无统计学意义(P=0.065)。PLT未恢复至150×10~9/L以上、接受无创辅助通气或经鼻高流量给氧、意识障碍、肾功能不全、心功能不全、感染性休克或发生出凝血事件与较差的预后相关，差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示，肌酐和PT是重症感染凝血异常的血液病患者预后的独立危险因素(P<0.05)。结论:不同预后组间肌酐水平、PT、INR、TT、PTA差异有统计学意义，其中肌酐水平和PT有可能作为重症感染凝血异常的血液病患者预后判断的指标。更多还原

【Abstract】 Objective: Due to disease factors and treatment-related factors, most patients with hematological diseases have low immune function and an increased risk of severe infections. Moreover, the in-hospital mortality rate of patients with severe infection-associated coagulopathy is significantly higher than that of patients with severe infection but without coagulopathy. A retrospective analysis was conducted on the clinical data of patients with hematological diseases complicated with severe infection-associated coagulopathy to explore the differences in indicators among different prognostic groups, aiming to provide a basis and reference for clinicians in identifying patients with poor prognosis. Methods: The clinical data of 50 patients with severe infection-associated coagulopathy in the Hematology Intensive Care Unit of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from October 1, 2024 to April 30, 2025 were collected. According to the infection control status and the recovery of coagulation function of the patients, they were divided into the improved group(n=13) and the poor prognosis group(n=37). The differences in general information, infection indicators, blood routine, blood biochemistry and coagulation function indicators during hospitalization between the two groups were compared. Results: There were no statistically significant differences in gender, age, C-reactive protein, serum procalcitonin, total bilirubin level, activated partial thromboplastin time, fibrinogen, D-dimer, fibrin degradation products, antithrombin Ⅲ activity(AT-Ⅲ), and platelet count(PLT) between the two groups(P>0.05). Compared with the improved group, the poor prognosis group had significantly higher creatinine levels, prothrombin time(PT), international normalized ratio(INR) and thrombin time(TT), and significantly lower prothrombin activity(PTA), with statistically significant differences(P<0.05). There were no statistically significant differences in the proportion of patients with granulocytopenia, PLT reduction to varying degrees, PLT decline>50% within 24 hours, liver dysfunction and arrhythmia(P>0.05). The primary diseases of the patients were mostly hematological malignancies. The recurrent/refractory/high-risk/unrelieved primary diseases in the poor prognosis group were higher than those in the improved group, but the difference was not statistically significant(P=0.065). PLT not recovering to above 150×10~9/L, receiving non-invasive assisted ventilation or nasal high-flow oxygen therapy, consciousness disorder, renal dysfunction, cardiac dysfunction, septic shock or bleeding events were associated with poorer prognosis, and the differences were statistically significant(P<0.05). The results of multivariate logistic regression analysis showed that creatinine and PT were independent risk factors for prognosis in patients with hematological diseases complicated with severe infection-associated coagulopathy(P<0.05). Conclusion: There were significant differences in creatinine levels, PT, INR, TT and PTA among different prognosis groups. Among them, creatinine levels and PT may potentially serve as indicators for predicting the prognosis of patients with hematological diseases complicated with severe infection-associated coagulopathy.更多还原