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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摘要: 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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关键词:
- 血栓弹力图 /
- D-二聚体 /
- 纤维蛋白(原)降解产物 /
- 脓毒症 /
- 弥散性血管内凝血
Abstract: Objective: To investigate the prognostic value of TEG combined with D-dimer/fibrin degradation product(FDP) ratio for sepsis complicated with disseminated intravascular coagulation(DIC).Methods: One hundred and seven patients with sepsis admitted to the ICU of our hospital from January 2018 to January 2020 were selected. Among them, 41 patients developed DIC(DIC group) and 66 patients did not develop DIC(sepsis group). Clinical outcome of DIC group was tracked and divided into death group(14 cases) and survival group(27 cases) according to survival. After diagnosis of sepsis, all patients were tested for TEG and coagulation indexes. The value of TEG parameters and D-dimer/FDP ratio in predicting the prognosis of DIC patients was analyzed by receiver operating characteristic curve(ROC).Results: R、K、LY30 and FDP in DIC group were higher than those in sepsis group(P<0.05), while αAngle and MA values, CI, D-dimer and D-dimer/FDP ratio were lower than those in sepsis group(P<0.05). DIC group R、K、LY30 and FDP increased as the APACHE Ⅱ score increases(P<0.05), αAngle and MA values, CI, D-dimer and D-dimer/FDP ratio decreased(P<0.05). 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)%]and FDP[(10.64±1.67) mg/L vs.(8.54±2.34) mg/L]in death group were higher than those in survival group(P<0.05), while αAngle[(44.60±3.69) ° vs.(52.12±3.65) °]and MA values[(24.02±0.69) mm vs.(36.35±3.02) mm], CI[(1.30±0.06) vs.(1.69±0.21) ], D-dimer and D-dimer/FDP ratio[(0.10±0.02) vs.(0.16±0.03) ]were lower than those in survival group(P<0.05). ROC analysis results showed that the MA value, αAngle and d-dimer/FDP ratio were of value in predicting the prognosis of patients with sepsis complicated with DIC. The AUC value of the three indicators combined to predict the prognosis of patients with sepsis complicated with DIC was 0.960(95%CI: 0.909~1.000), which was greater than the MA value, αAngle and D-dimer/FDP ratio(P<0.05).Conclusion: TEG combined with D-dimer/FDP ratio is beneficial to the monitoring of coagulation status in patients with sepsis complicated with DIC, which is of high value for the assessment of the condition and prognosis.-
Key words:
- thromboelastogram /
- d-dimer /
- fibrin degradation product /
- sepsis /
- diffuse intravascular coagulation
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[1] 严思棋,郭涛.弥散性血管内凝血诊断与相关分子标志物[J].临床血液学杂志,2019,32(1):13-15.
[2] Gando S,Shiraishi A,Yamakawa K,et al.Role of disseminated intravascular coagulation in severe sepsis[J].Thromb Res,2019,178:182-188.
[3] Iba T,Levy JH.Sepsis-induced Coagulopathy and Disseminated Intravascular Coagulation[J].Anesthesiology,2020,132(5):1238-1245.
[4] 武春丽,刘凤华.血栓弹力图检测在下肢动脉硬化闭塞症中的应用研究[J].临床血液学杂志,2019,32(4):307-310.
[5] 马海梅,张会英,宋丽清,等.D-二聚体/FDP比值在急性与陈旧性脑梗死诊断中的意义[J].中国实验诊断学,2009,13(4):504-506.
[6] 邓石荣,瞿长春,刘仲军,等.多器官功能障碍综合征患者的凝血功能变化与APACHE Ⅱ评分的关系[J].实用临床医学,2016,17(8):16-17.
[7] Singer M,Deutschman CS,Seymour CW,et al.The Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315(8):801-810.
[8] Iba T,Thachil J.Present and future of anticoagulant therapy using antithrombin and thrombomodulin for sepsis-associated disseminated intravascular coagulation:a perspective from Japan[J].Int J Hematol,2016,103(3):253-261.
[9] Semeraro N,Ammollo CT,Semeraro F,et al.Coagulopathy of AcuteSepsis[J].Semin Thromb Hemost,2015,41(6):650-658.
[10] Gonzalez E,Moore EE,Moore HB.Management of Trauma-Induced Coagulopathy with Thrombelastography[J].Crit Care Clin,2017,33(1):119-134.
[11] 曾庆波,宋景春,林青伟,等.血栓弹力图对热射病合并弥散性血管内凝血的诊断及预后判断价值[J].解放军医学杂志,2018,43(9):752-755.
[12] 曾庆波,宋景春,林青伟,等.创伤合并弥散性血管内凝血患者血栓弹力图诊断标准的临床研究[J].东南国防医药,2018,20(5):471-475.
[13] Adamzik M,Langemeier T,Frey UH,et al.Comparison of thrombelastometry with simplified acute physiology score Ⅱ and sequential organ failure assessment scores for the prediction of 30-day 30-day survival:a cohort study[J].Shock,2011,35(4):339-342.
[14] Ostrowski SR,Windelov NA,Ibsen M,et al.Consecutive thrombelastography clot strength profiles in patients with severe sepsis and their association with 28-day mortality:a prospective study[J].J Crit Care,2013,28(3):317,e1-11.
[15] Semeraro F,Ammollo CT,Caironi P,et al.D-dimer corrected for thrombin and plasmin generation is a strong predictor of mortality in patients with sepsis[J].Blood Transfus,2020,18(4):304-311.
[16] Gris JC,Cochery-Nouvellon E,Bouvier S,et al.Clinical value of automated fibrin generation markers in patients with septic shock:a SepsiCoag ancillary study[J].Br J Haematol,2018,183(4):636-647.
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