48例血栓性血小板减少性紫癜患者的临床特征及死亡危险因素分析

Analysis of clinical characteristics and risk factors of death in 48 patients with thrombotic thrombocytopenic purpura

目的:分析血栓性血小板减少性紫癜(TTP)患者的临床特征并探讨TTP死亡的危险因素。方法:回顾性分析2014-10—2019-10期间的48例TTP患者的临床资料及预后,按疾病转归将患者分为死亡组及缓解组,比较两组患者临床资料的差异,分析其临床特征及死亡危险因素。结果:①入组的48例TTP患者,其中男25例,女23例,平均年龄(49±15)岁。治疗(15±7.6) d,最终25例(52.08%)救治成功。②根据资料类型对两组各项指标进行统计学分析,提示死亡组与缓解组在MCV、网织红细胞计数、网织红细胞百分比等11个指标上差异有统计学意义(P<0.05)。③对上述11项指标进行Logistics单因素分析,发现肌红蛋白、GCS评分差异有统计学意义(P<0.05)。将肌红蛋白和GSC评分纳入Logistics多因素二元回归分析,构建的回归模型具有统计学意义(χ^2=26.2,P=0.000),结果显示肌红蛋白、GSC评分是死亡的危险因素;用2个变量联合诊断绘制ROC曲线,曲线下面积为0.86(95%CI:0.755~0.965)。结论:肌红蛋白和GCS评分是评价TTP预后的重要指标,对患者进行肌红蛋白测定和GCS评分有助于判断TTP的预后。

Objective:To analyze the clinical characteristics of patients with thrombotic thrombocytopenic purpura(TTP) and explore the risk factors for death. Method:The clinical data and prognosis of 48 cases of TTP diagnosed in our emergency department from October 2014 to October 2019 were retrospectively analyzed, and the patients were divided into death group and remission group according to disease outcome. The clinical characteristics and risk factors of death were analyzed. Result:①There were 25 males and 23 females in TTP patients, aged(49 ± 15) years old. After treatment of(15.0±7.6) days, 25 cases(52.08%) were successfully rescued. ②Statistical analyses were performed to test the data of the twogroups. There were statistically significant differences in 11 indicators such as MCV, reticulocyte count, and reticulocyte percentage between the death group and remission group(P<0.05). ③The 11 indicators were included in the Logistic single factor analysis, and the two indicators of myoglobin and GCS scores were found to be statistically significant(P<0.05). Incorporating myoglobin and GCS scores into the Logistics multivariate binary regression analysis, the regression model constructed was statistically significant(χ^2=26.2, P=0.000). The results showed that myoglobin and GCS scores were risk factors for death. The ROC curve was drawn using 2 variables combined diagnosis. The area under the curve was 0.86(95%CI:0.755, 0.965). Conclusion:Myoglobin and GCS scores are important indicators for assessing the prognosis of TTP. The measurement of myoglobin and GCS scores of patients can help physicians to predict the prognosis of TTP patients.