血栓调节蛋白和组织纤溶酶原激活物-纤溶酶原激活物抑制剂-1复合物在热射病中的诊断价值

Clinical significance of thrombomodulin and tissue plasminogen activator-plasminogen activator inhibitor-1 complex in heat-stroke

目的探讨热射病时血栓调节蛋白(TM)和组织纤溶酶原激活物-纤溶酶原激活物抑制剂-1复合物(t-PAIC)的临床价值。方法回顾性分析解放军联勤保障部队第九〇八医院重症医学科2016年6月至2022年9月收治的45例中暑患者,根据中暑严重程度分为热衰竭组(n=23)和热射病组(n=22)。收集患者入科2 h内的常规凝血项目和血栓弹力图(TEG)指标以及血栓标志物TM、凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2纤溶酶抑制剂复合物(PIC)、t-PAIC,并进行统计学分析。结果与热衰竭组患者TM[7.3(5.4,9.3)TU/m L]、TAT[2.6(1.5,7.2)ng/m L]、PIC[0.7(0.4,1.0)μg/m L]、t-PAIC[3.8(2.1,7.0)ng/m L]相比,热射病组患者TM[17.1(9.2,24.7)TU/m L]、TAT[23.4(10.4,44.3)ng/m L]、PIC[2.0(0.9,5.2)μg/m L]和t-PAIC[17.0(8.3,44.1)ng/m L]均升高(P<0.05)。单因素联合多因素Logistic回归分析显示,TM及t-PAIC为发生热射病的独立危险因素(P<0.05)。TM联合t-PAIC诊断热射病的ROC曲线下面积为0.916(95%CI:0.839~0.993,P<0.001),当TM>8.2 TU/m L、t-PAIC>8.7 ng/m L时,敏感性为95.5%,特异性为69.6%,阳性预测值为75.0%,阴性预测值为94.1%。结论热射病患者的TM、TAT、PIC和t-PAIC可升高,TM联合t-PAIC对热射病诊断有临床价值。

Objective To investigate the clinical significance of thrombomodulin(TM)and tissue plasminogen activator-plasminogen activator inhibitor-1 complex(tPAIC)in heatstroke.Methods A retrospective analysis was conducted on 45 heatstroke patients ad-mitted to the Intensive Care Unit of the 908th Hospital of PLA Logistic Support Force from June 2016 to September 2022.The patients were divided into 2 groups:heat exhaustion group(n=23)and heatstroke group(n=22)according to the severity of heat illness.The results of conventional coagulation tests,thromboelastogram(TEG),and coagulation markers,including TM,thrombin antithrombin complex(TAT),plasmin-α2anti-plasmin inhibitor complex(PIC)and t-PAIC within 2 hours after admission,were statistically ana-lyzed.Results Compared with the heat exhaustion patients,the plasma levels of TM[17.1(9.2,24.7)vs 7.3(5.4,9.3)TU/m L],TAT[23.4(10.4,44.3)vs 2.6(1.5,7.2)ng/m L],PIC[2.0(0.9,5.2)vs 0.7(0.4,1.0)μg/m L]and t-PAIC[17.0(8.3,44.1 vs 3.8(2.1,7.0)ng/m L]in the heat stroke patients were significantly increased(P<0.05).Combining univariate and multivariate Lo-gistic regression analysis,TM and t-PAIC were shown as the independent risk factors for heatstroke.The area under the ROC curve of TM combined with t-PAIC was 0.916(95%CI:0.839 to 0.993,P<0.001).When TM>8.2 TU/m L,t-PAIC>8.7 ng/m L,the sensitivi-ty,specificity,positive predictive value and negative predictive value were 95.5%,69.6%,75.0%,and 94.1%,respectively.Con-clusion The levels of TM,TAT,PIC and t-PAIC of the patients with heatstroke may significantly increase.The results of TM com-bined with t-PAIC should be of clinical value in the diagnosis of heatstroke.