新型冠状病毒肺炎所致凝血功能障碍及其对预后的影响

Coagulation dysfunction and its effect on prognosis in patients with coronavirus disease 2019 pneumonia

目的分析新型冠状病毒肺炎(COVID-19)感染患者血浆D-二聚体、血浆纤维蛋白(原)降解产物(FDPs)等凝血指标的特点,并探讨其对患者病情的预测价值。方法收集南京医科大学第二附属医院自2022年12月至2023年1月收治的COVID-19感染患者100例,分为轻型组(n=29例),中型组(n=40例)及重型/危重型组(n=31例)。记录患者血浆D-二聚体、FDPs等凝血相关指标水平,分析3组患者凝血指标水平的特点。采用SPSS 27.0软件进行数据分析。根据数据类型,组间比较分别采用LSD-t检验、方差分析、χ^(2)检验、Kruskal-Wallis检验及Bonfferoni校正检验。采用受试者工作特征(ROC)曲线评价FDPs、D-二聚体、年龄及联合分析对预测COVID-19感染患者病死的诊断价值。结果重型/危重型组患者高龄、合并基础疾病比例及死亡率高于轻型组、中型组,差异有统计学意义(P<0.05);中型组患者血浆FDPs水平、重型/危重型组患者血浆FDPs、D-二聚体水平均高于轻型组,差异有统计学意义(P<0.05);FDPs、D-二聚体、年龄、FDPs与D-二聚体两项联合分析、FDPs与D-二聚体、年龄三项联合分析的ROC曲线下面积分别为0.785(95%CI 0.645~0.926;P<0.01)、0.811(95%CI 0.691~0.03;P<0.01)、0.725(95%CI 0.558~0.891;P<0.05)、0.766(95%CI 0.581~0.951;P<0.05)、0.875(95%CI 0.789~0.962;P<0.01),灵敏度分别为90.9%、100.0%、72.7%、81.8%、100.0%,特异度分别为61.8%、50.6%、78.7%、71.9%、62.9%。结论COVID-19感染患者血浆D-二聚体、FDPs水平明显升高,且合并高龄对COVID-19感染疾病严重程度及不良预后具有重要预测价值。

Objective To analyze the characteristics of plasma D-dimer,fibrin degradation products(FDPs)and other coagulation indices in patients with coronavirus disease 2019(COVID-19)pneumonia and explore their predictive value for patient′s condition.Methods A total of 100 patients with COVID-19 pneumonia admitted to our hospital from December 7,2022 to January 28,2023 were enrolled and then divided into mild(n=29),moderate(n=40),and severe/critical infection(n=31)groups.Their plasma D-dimer,FDPs and other coagulation indices were recorded,and the characteristics of coagulation indices were analyzed in the three groups.SPSS statistics 27.0 was used for statistical analysis.LSD-t test,Fisher exact test,Kruskal-Wallis test,χ^(2) test or Bonferroni calibration test were employed for intergroup comparison depending on data type.Receiver operating characteristic(ROC)curve was plotted to evaluate the diagnostic value of FDPs,D-dimer,age,and their combination in predicting mortality in the COVID-19 infected patients.Results Larger proportions of older age and comorbidities and higher mortality were observed in the severe/critical groups than the mild and moderate groups(P<0.05).Plasma FDPs level in the moderate group and plasma FDPs and D-dimer levels in the severe/critical group were significantly higher than those in the mild group(P<0.05).The area under the curve(AUC)of FDPs,D-dimer,age,combined FDPs and D-dimer,and combination of FDPs,D-dimer and age in predicting mortality in the COVID-19 infected patients was 0.785(95%CI 0.645-0.926;P<0.01),0.811(95%CI 0.691-0.03;P<0.01),0.725(95%CI 0.558-0.891;P<0.05),0.766(95%CI 0.581-0.951;P<0.05)and 0.875(95%CI 0.789-0.962;P<0.01),respectively,and the sensitivity was 90.9%,100.0%,72.7%,81.8%and 100.0%,and the specificity was 61.8%,50.6%,78.7%,71.9%and 62.9%,respectively.Conclusion Plasma D-dimer and FDPs levels are significantly increased in COVID-19 patients.The two indicators combined with advanced age have an important predictive value for the severity and poor prognosis of COVID-19.