D-二聚体在危重病严重程度评估和预测中的临床应用

Application of D-dimer levels in assessment of disease severity and prognosis for ICU patients

目的前瞻性地研究D-二聚体与疾病的严重程度及预后是否存在相关性，以探讨D-二聚体水平在危重病患者中作为疾病严重程度评估和判断预后标志物的价值。方法选择自2009年4月1日至2009年12月1日期间ICU收治的137例危重患者为研究组，并随机选取40名健康志愿者为对照组，比较两者间D-二聚体水平差异。同时根据患者预后情况将研究组分为存活组和死亡组，分别记录收集患者年龄，入院时诊断，入科24、48hD-二聚体水平，24、48h急性生理学和慢性健康状态评价（APACHEⅡ），住ICU天数以及器官衰竭数目，并进行相关性研究分析。结果脓毒症、重症急性胰腺炎、严重创伤、手术后等疾病患者的D-二聚体水平较对照组明显升高（均P〈0．05）。存活组与死亡组之间D-二聚体水平，年龄、器官衰竭数目及APACHEⅡ评分也均存在显著差异（均P〈0．05）。D-二聚体水平与评估疾病的严重程度的APACHEⅡ、器官衰竭数目、住院死亡率呈正相关，而与ICU住院天数不相关。结论D-二聚体能够作为危重病患者疾病严重程度评估和预测患者预后的重要标志物，具有重要的临床应用价值。

Objective A prospective, observational study was conducted in correlation of D-dimer levels with prognostication and severity in critically ill patients, and investigate its effect of D-dimer levels in critical illness. Methods 137 cases of critically ill patients admitted in between April 1, 2009 and December 1, 2009 were selected into the research group while 40 healthy volunteers were randomly selected into the control group. The difference of D-dimer levels between the two groups were read and compared. Simultaneously, based on the prognosis, the patients were selected into the survival group and death group, records including age, sex, and diagnosis at admission. Their clinical characteristics such as Acute Physiology and Chronic Health Evaluation II （APACHE II） score and D-dimer level were recorded at 24 and 48 hours from the time of admission. Length of stay （LOS） in the ICU, organ Failure Number and in-hospital mortality were also recorded respectively. Then, a series of related research and analysis were carried out. Results In sepsis, severe acute pancreatitis, severe trauma, major surgery and other critical illness,the D-dimer level was significantly higher than that in the control group with significant difference （P〈0.05）. Between the survival group and death group, D-dimer levels, the number of organ failure, and APACHEⅡ scores also were significantly different （P〈0.05）. D-dimer levels were positively correlated with age, APACHE 11 scores which assess the severity of the disease, the number of organ failure and hospital mortality rate. Conclusion D-dimer level serves as a marker of disease severity with an incredible clinical value.