血小板联合D-二聚体评估创伤性凝血病患者的预后价值

The prognostic value of platelet combined with D-dimer in evaluating the patients with traumatic coagulopathy

目的研究血小板联合D-二聚体评估创伤性凝血病患者预后的价值.方法回顾性分析2018年10月至2019年10月苏州大学附属第一医院重症医学科收治的97例多发伤患者的资料,根据患者是否合并TIC,分为TIC组40例和创伤组57例.根据TIC的预后分为生存组26例和死亡组14例.统计患者的姓名、性别、年龄、住院号、凝血常规[活化部分凝血活酶时间(activated partial hromboplastin time,APTT)、抗凝血酶Ⅲ(antithrombinⅢ,AT-Ⅲ)、凝血酶原时间(prothrombin time,PT)、国际标准化比值(INR)、凝血酶时间(trombin time,TT)]、纤维蛋白原(fibrinogen,FIB)、血小板(PLT)计数、D-二聚体(D-dimer)及是否存活出院等,利用受试者工作特征(ROC)曲线评估血小板计数联合D-二聚体评估创伤性凝血病患者预后的价值.结果创伤性凝血病患者较创伤患者血小板计数显著降低[×10^9/L:128(66.5,163.0)vs.151(116.5,219.0),P<0.05]、D-二聚体显著升高[mg/L:7.0(3.4,18.0)vs.2.7(0.9,6.7),P<0.05];创伤性凝血病患者死亡组较生存组血小板计数显著降低[×10^9/L:67.0(45.5,99.2)vs.176.0(129.5,328.0),P<0.05]、D-二聚体显著升高[mg/L:18.9(6.6,20.0)vs.4.3(3.2,12.1),P<0.05].创伤性凝血病患者血小板计数降低、D-二聚体升高与创伤性凝血病的发生以及创伤性凝血病患者的预后有关,血小板计数联合D-二聚体评估创伤性凝血病患者预后的ROC曲线下面积(AUC)最大,为0.907(95%CI0.816~0.997,P<0.05).结论血小板联合D-二聚体评估创伤性凝血病患者的预后价值较大.

Objective To study the value of platelet combined with D-dimer in the prognosis of patients with trauma-induced coagulopathy.Methods Retrospective analysis of all data of 97 patients with multiple injuries admitted to the Department of Intensive Medicine of the First Affiliated Hospital of Soochow University from October 2018 to October 2019.The patients were divided into TIC group(40 cases)and trauma group(57 cases),and TIC group were further divided into two subgroups,the survival group(26 cases)and the death group(14 cases),according to TIC prognosis.The patientzs name,gender,age,hospitalization number,and blood coagulation indicator were recorded.Activated partial thromboplastin time(APTT),antithrombin Ⅲ(AT-Ⅲ),prothrombin time(PT),international normalized ratio(INR),thrombin time(TT)and fibrinogen(FIB),platelet(PLT),D-dimer(D-dimer),whether or not to be discharged from the hospital were the main analysis indexes.Receiver operating characteristic(ROC)curve assessed the prognostic value of blood platelet count combined with D-dimer in the patients with trauma-induced coagulopathy.Results Patients with trauma-induced coagulopathy had significantly lower platelet count[×10^9/L:128(66.5,163.0)vs.151(116.5,219.0),P<0.05]and significantly higher D-dimer[mg/L:7.0(3.4,18.0)vs.2.7(0.9,6.7),P<0.05]than those with trauma;The platelet count in the death group of patients with trauma-induced coagulopathy was significantly lower than that in the survival group[×10^9/L:67.0(45.5,99.2)vs.176.0(129.5,328.0),P<0.05],and the D-dimer was significantly increased[mg/L:18.9(6.6,20.0)vs.4.3(3.2,12.1),P<0.05].The decrease of blood platelet count and the increase of D-dimer in the patients with trauma-induced coagulopathy were related to the occurrence of trauma-induced coagulopathy and the prognosis of patients with trauma-induced coagulopathy.The area under curve of the prognosis of patients with trauma-induced coagulopathy evaluated by blood platelet count combined with D-dimer was the largest[0.907(95%CI 0.816-0.997,P<0.05)].Conclusion Blood platelet count combined with D-dimer has great prognostic value in evaluating the patients with trauma-induced coagulopathy.