新型冠状病毒大规模感染期门诊患者常规血液检测指标血栓风险分析

Analysis of thrombus risk factors for routine blood test indicators in outpatients during the largescale SARS-CoV-2 outbreak period

目的 探究新型冠状病毒(severe acute respiratory syndrome coronavirus 2, SARS-CoV-2)感染对轻型和普通型门诊患者的血栓风险影响。方法 以北京某三甲医院独立院区2022年新型冠状病毒感染政策调整后SARS-CoV-2病毒大规模感染期的门诊患者为研究对象,以政策调整前的动态清零期2022年、2021年、2020年同期门诊患者作为3个对照组,大规模感染期为观察组。入组病例去除了血栓性疾病、恶性肿瘤、女性妊娠期等引起凝血风险升高的生理因素。去除了14岁以下儿童患者。年龄以中位数(四分位间距)表示。利用统计方法和数据分析技术分析门诊患者血常规、纤维蛋白(原)降解产物(fibrin/fibrinogen degradation products, FDP)、D-二聚体(D-dimer, DD)的变化情况。结果 与对照组相比,观察组的红细胞、血红蛋白、红细胞压积3个指标降低,单核细胞、血小板计数2个指标升高,与3个对照组两两比较,差异均有统计学意义(P<0.0001)。与3个对照组相比,观察组的FDP和DD日超界值人数均明显增加,大于等于50岁年龄段FDP月均超界值人数升高了171%~793%,小于50岁年龄段FDP月均超界值人数升高了791%~2 068%。小于50岁患者的DD超界值月均人数升高48.98%以上,大于等于50岁患者的DD超阈值月均人数升高了346%~998%。结论 SARS-CoV-2感染门诊轻型和普通型门诊患者也存在栓塞增加的风险,建议加强监测DD等凝血指标以避免突发血栓相关的不良事件的发生。

Objective To investigate the impact of SARS-CoV-2 virus infection on the risk of thrombosis in COVID-19 outpatient patients with mild and regular symptoms.Methods Outpatient patients during the SARS-CoV-2 large-scale infection period after the policy adjustment for COVID-19 in Beijing in 2022 were selected as the observation group,and the dynamic zero-clearing period before the policy adjustment and outpatient patients during the 2022/2021/2020 period were taken as the three control groups.The patients with physiological factors that may increase the risk of coagulation,such as thrombotic diseases,malignant tumors,female pregnancy and other physiological factors,were excluded.Pediatric patients under 14 years old were also excluded.Age was expressed as median(interquartile).The changes in blood routine,fibrin/fibrinogen degradation products,and D-Dimer in Beijing outpatient patients were studied with statistical method and data analysis techniques.Results Compared with the control groups,the observation group showed a statistically significant decrease in red blood cells(RBC),hemoglobin(Hb),and hematocrit(HCT)levels,and an increase in monocytes(MONO)and platelet(PLT)counts,all showed statistically significant differences(P<0.0001).The proportion of fibrinogen degradation product(FDP)and D-Dimer of observation group exceeding the range increased significantly.Compared with the three control groups,the number of outpatient fibrinogen degradation products(FDP)in the observation group of patients aged 50 years and or older increased by 171%-793%,and the number of patients aged below 50 years increased by 791%-2068%.The monthly average number of patients under 50 years old in the observation group with D-Dimer exceeding the threshold increased by more than 48.98%,and the monthly average number of patients with D-Dimer exceeding the threshold in patients aged 50 or older increased by 346%-998%.Conclusions The results of this study suggest that outpatient patients with mild or regular SARS-CoV-2 infection are also at risk for thrombotic events,and monitoring blood coagulation indicators such as D-dimer is recommended to avoid the sudden onset of thrombosis-related fatal complications.