脓毒症患者血小板下降与感染性休克发生的相关性

Relationships between platelet decline in patients with sepsis and the occurrence of septic shock

目的分析脓毒症患者血小板下降情况及其与感染性休克发生的相关性。方法回顾性分析45例脓毒症患者血小板正常范围内下降(同时测同一时间点的TPO水平)与感染性休克发生前后的变化,以及发生感染性休克与未发生休克的脓毒症患者血小板计数变化(同一时间TPO水平)并同APACHEⅢ(急性生理学及慢性健康状况评分系统Ⅲ)评分对比分析得出。结果脓毒症患者诊断前PLT水平为(187.7±51.73)×109/L;脓毒症诊断后PLT水平为(126.1±38.71)×109/L,二者差异具有统计学意义(t=5.743,P<0.001);24例脓毒症未发生休克患者PLT下降,为(49.44±49.50)×109/L;21例感染休克患者PLT水平下降,为(90.19±44.86)×109/L;二者差异具有统计学意义(t=-2.896,P<0.001)。脓毒症患者诊断前后血小板计数下降和感染休克发生后血小板计数下降与APACHEⅢ评分均呈正相关关系(r=0.449、0.978,P<0.001)。结论血小板计数下降作为脓毒症患者病情变化的单独风险依据,可观察抗炎与促炎平衡状态的指标,无论血小板计数在否正常范围,下降的趋势更为重要。

Objective To analyze the platelet decline in patients with sepsis and its correlation with septic shock. Methods Total of 45 sepsis patients with platelets normal range decreased （TPO levels measured simultaneously at the same time） and the PLT levels before and after shock septic and the PLT counts in patients with or without septic shock （TPO levels at the same time） were analyzed retrospectively and comparative analysis was done by APACHEⅢscore draw. Results The PLT level of patients with sepsis before diagnosis was （187.7 ＆#177; 51.73） ＆#215; 109/L and after diagnosis was （126.1 ＆#177; 38.71） ＆#215;109/L, with signiifcant differences （t=5.743, P＆lt;0.001）. The PLT was decreased in 24 patients with sepsis who didn’t have shock, which was （49.44 ＆#177; 49.50） ＆#215; 109/L; the PLT was decreased in 21 patients with sepsis who suffered from shock, which was （90.19 ＆#177; 44.86） ＆#215; 109/L; with signiifcant differences （t=-2.896, P＆lt;0.001）. The decline of platelet count of patients with sepsis before and after diagnosis and that after infecting shock were both positively correlated with APACHEⅢscores （r=0.449, 0.978, P＆lt;0.001）. Conclusions The blood platelet count is takn as the individual risk basis for patients with sepsis and as the index of the balance between inlfammatory and anti-inlfammatory factors. No matter whether the blood platelet count is in the normal range, the declining trend is more important.