脓毒症患者凝血指标及炎症因子水平变化及临床意义

Changes and Clinical significance of Coagulation Indexes and inflammatory factors in patients with sepsis

目的:探讨细菌培养阳性的脓毒症患者凝血指标及炎症因子的水平及其临床意义。方法:选取2015年1月1日至2018年10月1日入住安徽医科大学第二附属医院急诊及ICU收治的117例的脓毒症患者临床资料,根据细菌培养结果及预后将其分为革兰阴性菌组和革兰阳性菌组,死亡组和存活组,比较各组D-二聚体、凝血四项(PT、APTT、TT、INR)、血小板(PLT)以及降钙素原(PCT)、白细胞介素6(IL?6)、白细胞(WBC)水平,建立ROC曲线分析评估上述指标预测脓毒症预后的预测效能。结果:革兰阴性菌组PCT、IL?6水平高于革兰阳性菌组,INR、APTT水平低于革兰阳性组,差异有统计学意义(P<0.05)。ROC曲线分析结果示INR、APTT、PT、D?二聚体、PCT、IL?6均对脓毒症患者预后有预测价值,以D-二聚体为优(AUC>0.7)。结论:PCT、IL?6及INR、APTT水平与细菌的种类相关,可作为在细菌培养结果出示之前,协助医师选择抗生素治疗方案。同时可联合检测D?二聚体及PT帮助评估预后。

Objective:To explore clinical significance of the level of coagulation index and inflammatory factor of sepsis patients with positive bacterial culture.Methods:Clinical data of one hundred and seventeen sepsis patients were enrolled.According to the results of bacterial culture and prognosis,they were divided into Gram positive bacteria group and Gram negative bacteria group,death group and survival group.The levels of D?dimer,PT,APTT,TT,INR,platelet(PLT),PCT,IL?6 and leukocyte(WBC)were compared in each group.ROC curve analysis was established to evaluate the predictive efficacy of the above indexes in predicting the prognosis of sepsis.Results:The level of PCT,IL?6 in Gram?negative bacteria group was higher than that in Gram?positive bacteria group,and the INR,APTT level in Gram?negative bacteria group was lower than that in Gram?positive group(P<0.05).the results of ROC curve analysis showed that INR,APTT,PT,D?dimer and PCT,IL?6 had predictive value for the prognosis of sepsis patients,and D?dimer was the best(AUC>0.7).Conclusion:The levels of PCT,IL?6 and INR,APTT were related to the type of bacteria.It can be used to help doctors select antibiotic treatments before showing the results of bacterial culture.Simultaneous detection of d?dimer can help assess prognosis.