发热伴血小板减少综合征患者D-二聚体、心肌酶谱及肝酶谱的检测

Detection of D-Dimer,Myocardial and Liver Enzymes in Patients with Fever and Thrombocytopenia Syndrome

目的探讨本地区发热伴血小板减少综合征患者发热期、多器官功能障碍期、恢复期三期D-二聚体、心肌酶谱和肝酶谱的动态变化规律,研究其临床意义。方法我院2011年3月~2015年12月收住院的124例发热伴血小板减少综合征患者回顾性分析。患者入院及后每2 d进行D-二聚体检测,早晨采空腹静脉血送检心肌酶谱、肝酶谱检测,至恢复期患者出院,记录各数据,进行统计学分析。结果发热期D-二聚体水平(2231.4±158.6)μg/L、多器官障碍期D-二聚体水平(1520.5±106.7)μg/L,与恢复期D-二聚体水平(321.9±35.3)μg/L相比,发热期、多器官障碍期D-二聚体水平明显升高,差异有统计学差异(P<0.01);多器官功能障碍期AST(183.1±67.1)U/L与发热期AST(372.9±90.0)U/L、恢复期AST(95.8±34.3)U/L对比明显升高,差异有统计学意义(P<0.05);普通型AST水平(259.8±65.8)U/L低于危重型AST水平(428.6±140),差异有统计学差异(P<0.05);普通型LDH(305.4±132.0)U/L、CK(284.4±118.0)U/L、CK-MB(96.5±18.8)U/L与危重型LDH(3902.3±187.4)U/L、CK(799.8±437.3)U/L、CK-MB(206.1±51.4)U/L对比差异有统计学意义(P<0.01),普通型ALT(96.66±42.16)、AST(156.1±37.1)与危重型ALT(372.9±61.6)、AST(651.8±34.3)比较差异显著,存在统计学差异(P<0.01)。结论发热伴血小板减少综合征患者D-二聚体、心肌酶谱早期便出现异常改变,且病情越重,D-二聚体、心肌酶谱升高越明显,但肝酶谱的改变有一定的滞后性,早期检测D-二聚体、CK水平可以识别发热伴血小板减少综合征危重病例、D-二聚体、CK水平下降预示病情好转,可以指导预后。

Objective To investigate the dynamic changes of D-dimer,myocardial enzyme spectrum and hepatic enzyme spectrum in patients who have fever accompanied by thrombocytopenia syndrome during the febrile,multiple organ dysfunction and convalescence period,study on its clinical significance as well.Methods From March 2011 to December 2015,124 cases of fever accompanied by thrombocytopenia syndrome were retrospectively analyzed.D-dimer was detected every 2 days after admission.In the morning,fasting venous blood was collected to test myocardial enzyme spectrum and liver enzyme spectrum,and the patients were discharged from the convalescence period.The data were recorded and analyzed statistically.Results The D-dimer level was(2231.4±158.6)μg/L during the febrile period and(1520.5±106.7)μg/L during multiple organ dysfunction period.Compared with convalescent D-dimer level(321.9±35.3)μg/L,D-dimer level in febrile period and multiple organ dysfunction period was significantly higher than that in convalescent period(P<0.01).AST level(183.1±67.1)U/L during multiple organ dysfunction period is significantly higher compared with that during the febrile period(372.9±90.0)U/L and convalescence period(95.8±34.3)U/L,the difference was statistically significant(P<0.05).LDH of common type(305.4±132.0)U/L、CK(284.4±118.0)U/L、CK-MB(96.5±18.8)U/L compared with LDH of critical type(3902.3±187.4)U/L、CK(799.8±437.3)U/L、CK-MB(206.1±51.4)U/L,there was statistical difference(P<0.01).And,ALT(96.66±42.16)、AST(156.1±37.1)of common type compared with critical type ALT(372.9±61.6)、AST(651.8±34.3),there was statistical difference(P<0.01).Conclusion In patients with fever accompanied by thrombocytopenia syndrome,abnormal changes of D-dimer and myocardial zymogram occur at the early stage,and the more serious the disease is,the more obvious the increase of D-dimer and myocardial enzyme spectrum are in patients with fever accompanied by thrombocytopenia syndrome.But the change of liver enzyme spectrum has a certain lag,early detection of D-dimer and CK level can identify the fever accompanied by thrombocytopenia syndrome in critical cases,the decrease of D-dimer and CK level indicates the improvement of the condition.It can guide the prognosis.