D-二聚体和C反应蛋白评估新型冠状病毒肺炎预后的临床应用价值

Clinical value of D-dimer and CRP in evaluating the prognosis of 2019 novel coronavirus-infected pneumonia

目的D-二聚体与C反应蛋白(CRP)与重症肺炎预后相关。文中探讨新型冠状病毒肺炎患者D-二聚体水平与炎症因子CRP的关联,及其评估临床预后价值。方法回顾性分析2020年2月4日-18日在武汉火神山医院接受治疗的242例新型冠状病毒肺炎患者临床资料,其中普通型131例、重型88例、危重型23例。比较不同严重程度及临床结局肺炎患者D-二聚体、CRP水平的差异,分析D-二聚体与CRP相关性。结果危重型及重型患者D-二聚体水平[(3.26±1.01)mg/L、(2.84±0.92)mg/L]显著高于普通型[(0.81±0.14)mg/L],差异有统计学意义(P<0.05);危重与重型患者相比,两者D-二聚体水平差异无统计学意义(P>0.05)。危重及重型患者CRP水平[(70.06±19.57)mg/L、(30.52±3.96)mg/L]显著高于普通型[(10.91±1.96)mg/L],差异有统计学意义(P<0.05);危重型患者CRP水平显著高于重型患者,差异有统计学意义(P<0.05)。入院30 d内新型冠状病毒肺炎死亡患者D-二聚体水平为[(7.55±1.67)mg/L],显著高于生存患者[(1.75±0.43)mg/L],差异有统计学意义(P<0.05)。30 d内死亡患者CRP水平[(85.91±19.69)mg/L]显著高于生存患者[(22.06±3.57)mg/L],差异有统计学意义(P<0.05)。Pearson相关分析结果显示,D-二聚体与CRP呈显著正相关(r=0.649,P<0.001)。结论D-二聚体、CRP水平与新型冠状病毒肺炎的严重程度相关,且在起病初期,两项指标的严重异常预示了疾病预后不良,提示在评估新型冠状病毒肺炎严重程度及预后方面上述二项指标具有一定价值。

Objective To investigate the relationship between the levels of D-dimer and inflammatory factors C-reactive protein(CRP)and prognosis in patients with 2019 novel coronavirus-infected pneumonia(COVID-19).Methods The clinical data of a total of 242 patients with COVID-19 who were treated in hospital from February 4 th 2020 to February 18 th 2020 were analyzed retrospectively.According to the classification standard,the patients with COVID-19 were divided into common patients(131 cases),severe patients(88 cases),and critical patients(23 cases).The difference between the levels of D-dimer and CRP in patients with pneumonia of different severity and clinical outcomes was compared and the correlation between D-dimer and CRP was analyzed.Results The levels of D-dimer and CRP in severe and critical patients were significantly higher than those in common patients(P<0.05).The levels of CRP in critical patients were significantly higher than those in severe patients(P<0.05).These two indicator levels of patients who died of COVID-19 within 30 days were significantly higher than those who survived.Pearson correlation analysis showed that the levels of D-dimer were positively correlated with the levels of CRP(r=0.649,P<0.05).Conclusion D-dimer and CRP are highly expressed in severe and critical patients,and the severe abnormality of the two indicators in the early stage of COVID-19 predicted the poor prognosis.D-dimer and CRP have certain clinical value in evaluating the severity and prognosis of COVID-19.