血栓弹力图联合D-二聚体/纤维蛋白(原)降解产物比值检测在脓毒症并发弥散性血管内凝血患者中的应用价值研究

张本蓉, 谢成兵. 血栓弹力图联合D-二聚体/纤维蛋白(原)降解产物比值检测在脓毒症并发弥散性血管内凝血患者中的应用价值研究[J]. 临床急诊杂志, 2021, 22(1): 31-35. doi: 10.13201/j.issn.1009-5918.2021.01.007
引用本文: 张本蓉, 谢成兵. 血栓弹力图联合D-二聚体/纤维蛋白(原)降解产物比值检测在脓毒症并发弥散性血管内凝血患者中的应用价值研究[J]. 临床急诊杂志, 2021, 22(1): 31-35. doi: 10.13201/j.issn.1009-5918.2021.01.007
ZHANG Benrong, XIE Chengbing. Application value of thromboelastogram combined with D-dimer/fibrin degradation product ratio in patients with sepsis complicated with disseminated intravascular coagulation[J]. J Clin Emerg, 2021, 22(1): 31-35. doi: 10.13201/j.issn.1009-5918.2021.01.007
Citation: ZHANG Benrong, XIE Chengbing. Application value of thromboelastogram combined with D-dimer/fibrin degradation product ratio in patients with sepsis complicated with disseminated intravascular coagulation[J]. J Clin Emerg, 2021, 22(1): 31-35. doi: 10.13201/j.issn.1009-5918.2021.01.007

血栓弹力图联合D-二聚体/纤维蛋白(原)降解产物比值检测在脓毒症并发弥散性血管内凝血患者中的应用价值研究

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    通讯作者: 谢成兵,E-mail:styq0235@163.com
  • 中图分类号: R737.9

Application value of thromboelastogram combined with D-dimer/fibrin degradation product ratio in patients with sepsis complicated with disseminated intravascular coagulation

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  • 目的:探讨血栓弹力图(TEG)联合D-二聚体/纤维蛋白(原)降解产物(FDP)比值对脓毒症并发弥散性血管内凝血(DIC)预后的预测价值。方法:选取2018年1月-2020年1月我院收治的107例脓毒症患者,其中41例患者发生DIC(DIC组),66例未发生DIC(非DIC组)。追踪DIC组临床结局,根据是否存活分为死亡组(14例)和存活组(27例)。所有患者确诊脓毒症后进行TEG和凝血指标检测。受试者工作特征曲线(ROC)分析TEG各参数和D-二聚体/FDP比值预测DIC患者预后的价值。结果:DIC组凝血反应时间(R)、血块生成时间(K)、LY30、FDP高于非DIC组(P<0.05),血细胞凝集块形成速(α角)、血凝块最大强度(MA值)、凝血综合指数(CI)、D-二聚体、D-二聚体/FDP比值低于非DIC组(P<0.05)。DIC组R、K、LY30、FDP随着APACHEⅡ评分增高而增高(P<0.05),α角、MA值、CI、D-二聚体、D-二聚体/FDP比值则降低(P<0.05)。死亡组R[(9.21±0.72) min vs.(6.53±1.42) min]、K[(5.32±2.42) min vs.(3.85±0.69) min]、LY30[(7.42±1.63)%vs.(5.29±1.52)%]、FDP[(10.64±1.67) mg/L vs.(8.54±2.34) mg/L]高于存活组(P<0.05),α角[(44.60±3.69)°vs.(52.12±3.65)°]、MA值[(24.02±0.69) mm vs.(36.35±3.02) mm]、CI(1.30±0.06 vs.1.69±0.21]、D-二聚体[(0.40±0.03) mg/L vs.(0.49±0.03) mg/L]、D-二聚体/FDP比值(0.10±0.02 vs.0.16±0.03)]低于存活组(P<0.05)。ROC分析结果显示MA值、α角、D-二聚体/FDP比值具有预测脓毒症并发DIC患者预后的价值,联合三项指标预测脓毒症并发DIC患者预后的AUC为0.960(95%CI:0.909~1.000),大于MA值、α角、D-二聚体/FDP比值(P<0.05)。结论:TEG联合D-二聚体/FDP比值有利于监测脓毒症并发DIC患者凝血状态,对病情评估和预后判断均有较高价值。
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收稿日期:  2020-11-17

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