APTT对发热伴血小板减少综合征预后的评估价值

Prognostic value of APTT in severe fever with thrombocytopenia syndrome

目的探讨活化部分凝血酶原时间(APTT)对发热伴血小板减少综合征(SFTS)患者预后判断的价值。方法收集2017年5月至2023年5月在大连医科大学附属第二医院确诊的62例SFTS患者为研究对象,其中男31例,女31例,平均年龄(64.48±8.96)岁。根据患者临床结局分为存活组(37例)及死亡组(25例),对两组患者的一般资料、基础疾病、入院后首次获得的一般实验室指标[血钾、血钙、血清铁蛋白(SF)、血清可溶性白细胞介素2受体(sIL2R)、白细胞(BWC)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐(Cr)、肌钙蛋白(cTnI)]及凝血指标[APTT、凝血酶原时间(PT)、抗凝血酶Ⅲ(ATⅢ)、凝血酶时间(TT)、纤维蛋白/纤维蛋白原降解产物(FDP)和血小板(PLT)]进行比较,采用二元Logistic回归分析疾病预后的独立危险因素,以ROC曲线评估APTT对SFTS患者临床结局的预测价值。结果死亡组患者意识障碍比例、肾损伤比例、血钙、APTT、PT、ATⅢ均高于存活组(P<0.05)。单因素和多因素Logistic回归分析发现,血钙是SFTS患者死亡的独立危险因素(OR=0.02,95%CI 0.00~0.76,P=0.007)。APTT单独预测SFTS患者死亡结局,其敏感性为66.7%,特异性为85.7%,曲线下面积为0.799,P均<0.05。APTT分别联合血钙、ATⅢ、CRP预测SFTS患者死亡结局,其敏感性分别为88.9%、77.8%、77.8%,特异性分别为81.0%、76.2%、66.7%,曲线下面积分别为0.889、0.815、0.772,P均<0.05。结论SFTS以意识障碍、凝血功能异常、肾损伤和低钙为特征,APTT独立或联合血钙在评估SFTS患者病情预后方面具有重要的临床价值。

Objective To study the value of APTT in predicting the prognosis of patients with severe fever with thrombocytopenia syndrome(SFTS).Methods Sixty-two patients with SFTS diagnosed in the Second Affiliated Hospital of Dalian Medical University from May 2017 to May 2023 were enrolled in the study,including 31 male and 31 female with an average age of(64.48±8.96)years.The patients were divided into survival group(37 cases)and deceased group(25 cases)according to their clinical outcomes.The general information,underlying diseases,general laboratory indexes(including potassium,calcium,SF,sIL2R,WBC,ALT,AST,Cr,cTnI)and coagulation indexes(including APTT,PT,ATⅢ,TT,FDP,PLT)were compared.The independent risk factors for disease prognosis were analyzed by binary logistic regression,and the predictive value of APTT for clinical outcomes in SFTS patients was assessed using ROC curves.Results The proportion of patients with impaired consciousness and renal impairment,and blood calcium,APTT,PT,and ATⅢlevels were higher in the deceased group compared to the survival group(P<0.05).Univariate and multivariate logistic regression analysis revealed that blood calcium was an independent risk factor for mortality in SFTS patients(OR=0.02,95%CI 0.00-0.76,P=0.007).In predicting mortality outcome in SFTS patients,APTT alone had a sensitivity of 66.7%and specificity of 85.7%,and an area under the curve of 0.799,all P<0.05.The sensitivities were 88.9%,77.8%and 77.8%,specificities 81.0%,76.2%,and 66.7%,and areas under the curve 0.889,0.815 and 0.772(all P<0.05)when APTT was combined with blood calcium,ATⅢand CRP,respectively.Conclusion SFTS is characterized by impaired consciousness,coagulation abnormalities,renal impairment,and low calcium level.APTT,either independently or in conjunction with blood calcium,has significant clinical value in assessing the prognosis of SFTS patients.