弥散性血管内凝血评分在脓毒症中的应用

The application of disseminated intravascular coagulation score in sepsis

目的研究弥散性血管内凝血（DIC）评分系统与脓毒症患者病情评估及预后间的关系。方法回顾性分析2005年1月-2008年12月本院重症监护病房（ICU）收治315例脓毒症患者的资料，按住院28d的预后分为生存组（194例）与死亡组（121例）。比较两组患者血小板计数（PLT）、纤维蛋白原（Fib）、凝血酶原时间（PT）及纤维蛋白单体的差异；用logistic单因素回归分析急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、DIC评分与预后的关系，评价APACHEⅡ评分、DIC评分在脓毒症诊断中的价值。结果死亡组PLT、Fib显著低于生存组，PT、活化部分凝血活酶时间（APTT）、凝血时间（ACT）和纤维蛋白单体值显著高于生存组，且APACHEⅡ评分、DIC评分显著高于生存组（P〈0．05或P〈0．01）。APACHEⅡ评分、DIC评分与脓毒症预后间均呈显著正相关[DIC评分：χ^2=17．741，P〈0．001，优势比（0R）=1．413，95％可信区间（CI）为1．203～1．659；APACHEⅡ评分：χ^2=36．456，P〈0．001，OR=1．109，95％CI为1．072～1．1473。APACHEⅡ评分曲线下面积（0．706）高于DIC评分曲线下面积（0．611）。结论APACHEⅡ评分、DIC评分均可作为脓毒症预后的预测指标，但DIC评分对脓毒症的诊断和预后判断价值低于APACHEⅡ评分。

Objective To study the relationship between the disseminated intravascular coagulation （DIC） score and assessment of illness and prognosis in sepsis. Methods A retrospective analysis of 315 patients with sepsis that admitted into the First Affiliated Hospital of Zhengzhou University hospital intensive care unit （ICU） from January 2005 to December 2008 was made. The patients were divided into survival group （194 cases） and death group （112 cases） according to the outcome within 28 days. The difference of the platelet （PLT） count, fibrinogen （Fib）, prothrombin time （PT）, and fibrin monomer were compared between two groups. The relationship between acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score, DIC score and prognosis were analyzed by univariate logistic regression analysis, then APACHE Ⅱ score and DIC score in sepsis were evaluated. Results PLT count and Fib of the death group were lower than those of the survival group, PT, activated partial thrombin time （APTT）, activated clotting time （ACT） and fibrin monomer of the death group were higher than those of the survival group. APACHE Ⅱ score and DIC score of the death group were higher than those of the survival group （P〈0. 05 or P〈0.01）. There was a positive correlation among APACHE I score, DIC score and the prognosis of sepsis （DIC score ： χ^2 = 17. 741, P〈0. 001, odds ratio （OR） = 1. 413, 95% confidence interval （CI） 1. 203 1. 659 ; APACHE I score： χ^2=36. 456, P〈0. 001, OR=1. 109, 95% CI 1. 072 - 1. 1473. Area under the curve of APACHE Ⅱ score （0. 706） was higher than DIC score （0. 611）. Conclusion APACHE Ⅱ score and DIC score can be used as the prognostic factors of sepsis, but the value of DIC score was lower than APACHE Ⅱ score in diagnosis and prognosis of sepsis.