D二聚体预测中暑患者发生热射病的多中心回顾性研究

A multicenter retrospective study of D⁃dimer levels in predicting heat stroke in patients with heat illness

目的探讨D二聚体预测中暑患者发生热射病的临床价值。方法回顾性分析2021年3月—2021年11月24家医院急重症医学科收治的277例中暑患者的临床资料。收集患者入院2 h内的基本指标(年龄、心率、收缩压、舒张压),血常规指标(血红蛋白、血小板计数),常规凝血指标(凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、凝血酶时间),肝肾功能指标(丙氨酸氨基转移酶、天门冬氨酸氨基转移酶和肌酸激酶),以D二聚体是否>0.5μg/mL分为D二聚体正常组(n=176)和D二聚体升高组(n=101),并进行统计学分析。结果使用广义可加模型确定血浆D二聚体含量与热射病发生率呈U型曲线关系。校正混杂因素后,多因素Logistic回归分析显示,D二聚体水平升高是患者发生热射病的显著因子[Crude model(D二聚体):OR 3.28(95%CI:1.95~5.52,P<0.001)]、[modelⅠ(D二聚体、年龄、心率、收缩压、舒张压):OR 2.21(95%CI:1.25~3.91,P=0.006)]、[modelⅡ(D二聚体、年龄、心率、收缩压、舒张压、血红蛋白、血小板计数凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、凝血酶时间):OR 1.97(95%CI:1.02~3.82,P=0.045)]。结论高水平的D二聚体是中暑患者发生热射病的独立危险因素。

Objective To explore the clinical value of D⁃dimer in predicting heat stroke in patients with heat illness.Methods The clinical data of 277 patients with heat stroke treated in the emergency and critical care medicine department of 24 hospitals from March 2021 to November 2021 were analyzed retrospectively,including basic indexes(age,heart rate,systolic blood pressure and diastolic blood pressure),whole blood cells indexes(hemoglobin and platelet count),routine coagulation indexes(prothrombin time,activated partial thromboplastin time,fibrinogen and thrombin time),liver and kidney function indexes(alanine aminotransferase,aspartate aminotransferase and creatine kinase).Patients were divided into normal D⁃dimer group(n=176)and elevated D⁃dimer group(n=101)according to D⁃dimer values.Results The relationship between plasma D⁃dimer and the incidence of heat stroke was U⁃shaped curve.After adjusting for confounding factors,multivariate logistic regression analysis showed that the increase of D⁃dimer levels was a significant risk factor for the occurrence of heat stroke[crude model(D⁃dimer):or 3.28(95%CI:1.95~5.52,P<0.001)],[modelⅠ(D⁃dimer,age,heart rate,systolic blood pressure,diastolic blood pressure):or 2.21(95%CI:1.25~3.91,P=0.006)][modelⅡ(D⁃dimer,age,heart rate,systolic blood pressure,diastolic blood pressure,hemoglobin,platelet count,prothrombin time,activated partial thromboplastin time,fibrinogen,thrombin time):or 1.97(95%CI:1.02~3.82,P=0.045)].Conclusion Increased D⁃dimer level is an independent risk factor for heat stroke in patients with heat illness.