D-二聚体与成人不同类型脓毒症的关系

Relationship between D-dimer and different types of sepsis in adults

目的探讨血液中D-二聚体水平与成人不同类型脓毒症的关系方法按年份随机抽取脓毒症患者873例,按照纳入排除标准共筛选出484例,分别按培养出细菌类型、患者严重程度和预后进行分组,统计患者的感染来源、性别、年龄、D-二聚体水平以及急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分,采取不同统计方法进行分析.结果不同感染类型的脓毒症患者血液中D-二聚体的水平各不相同G-菌患者中D-二聚体的水平较其他二者高(P<0.05),G+菌患者中D-二聚体的水平较真菌感染者高(P<0.05),各个组中的不同菌属也不相同;不同严重类型的脓毒症患者随着严重程度依次增加,患者年龄、D-二聚体水平、APACHEⅡ评分和病死率呈阶梯式增长(P<0.05),治疗前和经治疗72 h血液D-二聚体水平和APACHEⅡ评分均出现不同程度的下降,两者经Pearson相关性分析,均呈正相关(r=0.867,P<0.05;r=0.913,P<0.05);不同预后类型的脓毒症患者死亡组患者D-二聚体水平和APACHEⅡ评分均高于生存组(P<0.05),在生存组患者中,D-二聚体水平和APACHEⅡ评分经Pearson相关性分析呈正相关(r=0.632,P<0.05),而在死亡组中二者呈零相关.结论不同感染类型脓毒症患者血液D-二聚体的水平不相同,D-二聚体水平可以用来评价患者病情严重程度和预后,并对治疗效果的评价也可能存在作用.

AIM To investigate the relationship between the level of D-dimer in blood and different types of sepsis in adults.METHODS Eight hundred and seventy-three sepsis patients were randomly selected according to the year of diagnosis,of whom 484 were screened according to the inclusion criteria.The patients were grouped according to the cultivated bacterium type,the severity and prognosis,and infection source,gender,age,D-dimer level and acute physiology and chronic health evaluation Ⅱ（APACHEⅡ） score were compared between different groups.RESULTS The levels of D-dimer in the blood of patients with different types of infection were different.The level of D-dimer was significantly higher in patients with G~ bacterial infection than in those with G~＋ bacterial infection and fungal infection（P 〈 0.05）,and in those with G~＋bacterial infection than in those with fungal infection（P 〈 0.05）.The level of D-dimer was also different among different genera in each group.With the increase in the severity of sepsis,patient age,D-dimer levels,APACHE II score and mortality showed a gradual growth pattern（P 〈 0.05）.Compared with the values before treatment,blood D-dimer levels and APACHEII scores at 72 h after treatment decreased in different degrees,and there was a positive correlation between them（P 〈 0.05,r =0.913;P 〈 0.05,r = 0.867）.The levels of D-dimer and APACHEII scores were higher in the death group than in the survival group（P 〈 0.05）.D-dimer levels and APACHEII scores were positively correlated in the survival group（r =0.632,P 〈 0.05）,but not in the death group.CONCLUSION The levels of blood D-dimer in different types of patients with sepsis are not the same.D-dimer level can be used for evaluation of severity and prognosis of sepsis patients.