动态监测血小板计数对脓毒症患者预后评价的意义

Prognostic significance of dynamic monitoring of platelet count in patients with sepsis

目的:探讨血小板(platelet,PLT)计数的变化对脓毒症患者的临床预后价值。方法 :测定并记录128例脓毒症患者确诊第1、3和5天的PLT计数水平,统计患者确诊当天的急性生理与慢性健康评分(acute physiology and chronic health evaluation,APACHE)Ⅱ;根据患者28 d转归分为存活组(96例)和死亡组(32例),比较第1、3、5天PLT计数水平在2组的变化,同时分析其与APACHEⅡ及脓毒症患者预后的关系。结果:(1)死亡组PLT计数在第1、3和5天均低于存活组(P<0.05),且呈持续下降趋势,差异有统计学意义;存活组PLT计数在第3天明显下降,第5天又有所上升;(2)相关分析示APACHEⅡ第1、3和5天的PLT计数均呈显著负相关。(3)工作特征曲线分析示PLT计数第1、3和5天预测脓毒症患者生存的工作特征曲线下面积(area under curve,AUC)分别为0.737(0.614～0.860)、0.920(0.854～0.986)、0.995(0.985～1.000),其中, PLT第5天AUC最大,预测脓毒症患者生存的价值优于第1天和第3天,当PLT第5天为62.5×109/L时,灵敏度为95.8%,特异度为100.0%。结论:PLT可作为脓毒症患者病情及预后的血液学评价指标,动态监测效果更佳。

Objective To investigate the prognostic value of platelet(PLT)count in patients with sepsis.Methods The PLT count was detected and recorded at 1st,3rd and 5th day of sepsis in 128 patients,and the acute physiology and chronic health evaluation(APACHE)Ⅱscore was calculated at 1 st day of sepsis.According to the survival at 28 days,patients were divided into survival group(96 cases)and death group(32 cases).Compared the changes of PLT count at each time and analyzed the relationship between PLT count,APACHEⅡscore and prognosis of sepsis patients.Results PLT count in the death group was significantly lower than that in the survival group at different time points(P<0.05),and the PLT count in death group showed a significant downward trend.In the survival group,PIT count decreased significantly at 3rd day and increased again at 5th day.Correlation analysis showed that there was a negative correlation between APACHEⅡscore and PLT count.Receiver operator characteristic(ROG)curve analysis showed that the area under the curves(AUC)of PLT count at 1st day(PLT 1),3rd day(PLT3)and 5th day(PLT5)to predict the survival of patients with sepsis were 0.737(0.614-0.860).0.920(0.854-0.986),0.995(0.985-1.000),respectively;cutoff value of 62.5xl0^9/L for PLT5 conferred the highest sensitivity(95.8%)and specificity(100.0%)in predicting the survival of patients.Conclusions PLT can be used as a hematological indicator for evaluating the severity and prognosis of patients with sepsis,and namic monitoring is the better.