老年社区获得性肺炎呼吸衰竭患者凝血功能的变化及其临床意义研究

Change of coagulation function of elderly community-acquired pneumonia patients complicated with respiratory failure and its clinical significance

目的研究和分析老年社区获得性肺炎(CAP)并发呼吸衰竭(RF)患者凝血功能的变化及其与动脉血氧水平、疾病严重程度评分等指标的相关性。方法选取2016年2月-2017年3月医院收治的106例老年CAP患者,根据是否合并RF将患者分为CAP组(57例)和RF组(49例),同期选取50名健康志愿者作为对照组;对三组研究对象外周血凝血酶原时间(PT)、部分活化凝血酶原时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)、血小板计数(PLT)等凝血功能指标进行检测和比较;并对CAP组和RF组患者的动脉血氧分压(PaO2)及CURB-65评分进行比较。结果 RF组患者的PT、APTT、D-D水平均高于CAP组和对照组,FIB、PLT水平均低于CAP组和对照组,各组间差异均有统计学意义(P<0.05);RF组患者的动脉血PaO2水平低于CAP组,CURB-65评分高于CAP组(P<0.05);直线相关分析结果显示,RF组患者的动脉血PaO2水平与PT、APTT、D-D水平呈负相关(P<0.05),CURB-65评分与PT、APTT、D-D水平呈正相关(P<0.05)。结论老年CAP患者体内存在着凝血功能异常,特别是合并RF患者的改变更加显著,其凝血功能指标与病情的严重程度具有相关性,可作为评价病情的辅助指标。

OBJECTIVE To observe the change of coagulation function of the elderly community-acquired pneumonia（CAP）patients complicated with respiratory failure（RF）and analyze its relationship with arterial oxygen level and score of severity of diseases.METHODS A total of 106 elderly patients with CAP who were treated in hospitals from Feb 2016 to Mar 2017 were enrolled in the study and divided into the CAP group with 57 cases and the RF group with 49 cases according to the complication with RF,meanwhile,50 healthy volunteers were selected as the control group.The coagulation function indexes such as peripheral blood prothrombin time（PT）,activated partial thromboplatin time（APTT）,fibrinogen（FIB）,D-dimer（D-D）and platelets（PLT）counts were detected and compared among the three groups of study objects,and the partial pressure of arterial oxygen（PaO_2）and CURB-65 score were compared between the CAP group and the RF group.RESULTS The levels of PT,APTT and D-D of the RF group were higher than those of the CAP group and the control group,the levels of FIB and PLT of the RF group were lower than those of the CAP group and the control group,and there were significant differences（P〈0.05）.The arterial blood PaO_2 of the RF group was lower than that of the CAP group,and the CURB-65 score of the RF group was higher than that of the CAP group（P〈0.05）.The result of linear correlation analysis showed that the arterial blood PaO_2 level of the patients in the RF group was negatively correlated with the levels of PT,APTT and D-D（P〈0.05）,and the CURB-65 score was positively correlated with the levels of PT,APTT and DD（P〈0.05）.CONCLUSIONThe elderly patients with CAP have the abnormal coagulation function,the patients complicated with RF have significant change of the coagulation function,whose coagulation function indexes are associated with the severity of disease,and they can be used as auxiliary indexes for evaluation of illness condition.