脓毒症患者血浆抗凝血酶Ⅲ及D-二聚体与SOFA评分的相关性研究

Correlative study between the changes of antithrombin Ⅲ activity & D-dimer level and sequential organ failure assessment score in the patients with sepsis

目的探讨脓毒症患者血浆抗凝血酶Ⅲ(AT-Ⅲ)活性、D-二聚体(D-dimer)与序贯器官衰竭评估(SOFA)评分的关系及其对病情严重程度的判断价值。方法选取2006年1月至2007年1月在宁夏医学院附属医院ICU住院治疗的101例脓毒症患者,测定其明确诊断后24h内的AT-Ⅲ活性和D-dimer质量浓度,同时记录呼吸、凝血、循环、中枢神经系统及肾脏、肝脏的SOFA评分。依据多器官功能障碍综合征(MODS)发生与否分为MODS组(46例)和非MODS组(55例);比较不同SOFA评分分段AT-Ⅲ活性和D-dimer质量浓度的差异,并进行相关性分析。结果MODS组D-dimer质量浓度和SOFA评分均显著高于非MODS组(P<0.05和P<0.01),AT-Ⅲ活性显著低于非MODS组(P<0.01);MODS组呼吸、循环、中枢神经系统凝血及肾脏的SOFA评分显著高于非MODS组(P均<0.01);不同SOFA评分分段AT-Ⅲ活性和D-dimer质量浓度变化差异均有显著性意义(P<0.01);AT-Ⅲ活性与SOFA评分呈明显负相关(r=-0.536,P<0.01);D-dimer质量浓度与SOFA评分呈明显正相关(r=0.410,P<0.01)。结论脓毒症患者存在明显的凝血功能障碍,血浆AT-Ⅲ活性和D-dimer测定及SOFA评分系统对于脓毒症患者病情严重程度的评估有良好的应用价值。

Objective To observe the relationship between the changes of antithrombin Ⅲ（ AT- Ⅲ ） activity ＆ D-dimer level and sequential organ failure assessment（SOFA） score in the patients with sepsis, and to study the value in estimating the severity of illness. Methods From January 2006 to January 2007, a total of 101 cases with sepsis in the intensive care unit（ICU） in Affiliated Hospital of Ningxia Medical College were divided into MODS group and non-MODS group according to the criteria of MODS. Blood samples were collected immediately after sepsis defined, and the activity of AT-Ⅲ ＆ the level of D-dimer were measured in all patients. And SOFA score was calculated. Divide 101 patients into four groups according to different SOFA score by Quqrtile, then to compare the activity of AT- Ⅲ ＆ the level of D-dimer among them. Then we analyzed the relationship between the above indicators. Results Compared with non-MODS group the level of Ddimer and SOFA score were dramatically higher（ P 〈 0. 05 or P 〈 0. 01 ）, while the activity of AT- Ⅲ was significantly lower（ P 〈0. 01 ）in MODS group. The SOFA score for respiratory, coagulation, cardiovascular, renal systems and the central nervous system was markedly different between MODS group and non-MODS group（ P 〈 0. 01 ）. The activity of AT-Ⅲ ＆ the level of D-dimer were significantly different among groups with different SOFA score by Quqrtile（ P 〈 0. 01 ）. SOFA score correlated well with the activity of AT-Ⅲ and the level of D-dimer（ P 〈 0. 01 ）. Conclusion There are the dysfunctions of coagulation in the patients with sepsis. The activity of AT-Ⅲ ＆ the level of D-dimer can be used to evaluate the severity of critical ill patients with sepsis, which can also be assessed by the SOFA score based on the degree of organ dysfunction.