脓毒症患者血乳酸、肌钙蛋白、凝血指标动态变化特点及其与患者预后关系

Dynamic changes of blood lactic acid,troponin and coagulation indexes in sepsis patients and their relationship with the severity of illness and survival

目的探讨脓毒症患者血乳酸(Lac)、心肌肌钙蛋白I(cTnI)、心肌肌钙蛋白T(cTnT)、凝血指标动态变化特点及其与患者病情程度和生存情况的关系。方法回顾性选取2019年3月—2022年3月在我院治疗的脓毒症患者129例,根据入院后24 h内是否发生休克分为两组,发生休克者48例为脓毒性休克组,未发生休克者81例为脓毒症组。检查患者外周血Lac、cTnI、cTnT、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)和纤维蛋白原(Fib)差异。结果脓毒性休克组Lac、cTnI、cTnT、APTT、PT、TT及APACHEⅡ评分明显高于脓毒症组(P<0.05),而Fib明显低于脓毒症组(P<0.05)。Lac、cTnI、cTnT、APTT、PT、TT与与APACHEⅡ评分呈正相关(P<0.05),Fib与APACHEⅡ评分呈负相关(P<0.05)。脓毒性休克、脓毒症患者治疗后24、72 h时组Lac、cTnI、cTnT、APTT、PT及TT明显高于治疗前(P<0.05),而Fib明显低于治疗前(P<0.05)。脓毒性休克组死亡患者治疗前后Lac、cTnI、cTnT、APTT、PT及TT及Fib变化值明显高于存活患者(P<0.05)。治疗前后Lac、cTnI、cTnT、PT及TT及Fib变化值预测脓毒症休克患者死亡的ROC曲线下面积分别为0.940、0.684、0.688、0.724、0.726和0.690(P<0.05)。结论脓毒症患者病情越严重,其血乳酸、肌钙蛋白、凝血指标表现越差,同时各指标呈持续加重;血乳酸、肌钙蛋白、凝血指标治疗前后变化值在预测脓毒休克患者预后方面有一定应用价值。

Objective To investigate the dynamic changes of blood lactate(Lac),cardiac troponin I(cTnI),cardiac troponin T(cTnT)and coagulation indexes in patients with sepsis and their relationship with disease severity and survival.Methods 129 patients with sepsis who were treated in our hospital from March 2019 to March 2022 were retrospectively selected.They were divided into the two groups according to whether shock occurred within 24 hours after admission.48 patients with shock were septic shock group,and 81 patients without shock were septic shock group.The peripheral blood Lac,cTnI,cTnT,activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT)and fibrinogen(Fib)were examined.Results The scores of Lac,cTnI,cTnT,APTT,PT,TT and APACHEⅡin the septic shock group were(9.10±1.08)mmol/L,(10.40±1.18)μg/L,(11.18±1.72)μg/L,(41.58±6.03)s,(16.30±2.18)s,(20.50±2.71)s and(17.05±2.50)respectively,which were significantly higher than those in the sepsis group(P<0.05),while the Fib was(2.51±0.81)g/L,which was significantly lower than that in the sepsis group(P<0.05).Lac,cTnI,cTnT,APTT,PT,TT were positively correlated with APACHEⅡscore(P<0.05),while Fib was positively correlated with APACHEⅡscore(P<0.05).Lac,cTnI,cTnT,APTT,PT and TT in septic shock and sepsis patients at 24h and 72h after treatment were significantly higher than those before treatment(P<0.05),while Fib was significantly lower than those before treatment(P<0.05).The changes of Lac,cTnI,cTnT,APTT,PT,TT and Fib in dead patients with septic shock before and after treatment were significantly higher than those in survivors(P<0.05).The area under the ROC curve of predicting death in septic shock patients by the change values of Lac,cTnI,cTnT,PT,TT and Fib before and after treatment in septic shock patients was 0.940,0.684,0.688,0.724,0.726 and 0.690,respectively(P<0.05).Conclusion The more serious the sepsis patients are,the worse their blood lactic acid,troponin and blood coagulation indicators are,and the indicators continued to worsen before and after treatment.The changes of blood lactic acid,troponin and coagulation indexes before and after treatment have certain application value in predicting the prognosis of septic shock patients.