新型凝血、纤溶标志物对脓毒症性凝血病的诊断及预后价值分析

Analysis of diagnosis and prognosis values of novel coagulation and fibrinolysis markers in sepsis coagulation disease

目的探讨新型凝血、纤溶标志物对脓毒症性凝血病(SIC)的诊断及预后价值。方法回顾性分析2022年7月至2023年3月该院收治的153例脓毒症患者资料,根据2017年国际血栓与止血学会(ISTH)发布的SIC诊断标准,将患者分为SIC组(n=55)和普通脓毒症组(SA组,n=98)。收集患者基本资料、随访情况,采用多因素logistic回归分析脓毒症患者发生SIC的影响因素,受试者工作特征(ROC)曲线分析相关指标对脓毒症患者发生SIC的预测效能,纳入2023年4-7月的66例脓毒症患者进行验证,Kaplan-Meier生存曲线分析患者生存情况。结果两组急性生理与慢性健康状况评分系统(APACHEⅡ)评分、序贯性器官衰竭评估(SOFA)评分、凝血酶原时间(PT)、PLT、D-二聚体(D-D)、凝血酶抗凝血酶复合物-Ⅲ(AT-Ⅲ)、组织型纤溶酶原激活物-纤溶酶原激活抑制物-1复合物(t-PAIC)、血栓调节蛋白(TM)比较差异有统计学意义(P<0.05)。多因素logistic回归分析显示,PT、PLT、D-D、t-PAIC、TM是脓毒症患者发生SIC的独立影响因素(P<0.05)。PT、PLT、D-D、t-PAIC、TM联合检测可提高预测效能[曲线下面积(AUC)=0.914],该模型拟合良好(χ^(2)=12.593,P=0.127);验证组显示其具有较好的预测效能(AUC=0.888),该模型拟合良好(χ^(2)=7.996,P=0.333)。t-PAIC<19.27μg/mL组比t-PAIC≥19.27μg/mL组、TM<16.11 TU/mL组比TM≥16.11 TU/mL组的中位OS时间更长(P<0.05)。结论基于影响因素构建的模型对脓毒症患者发生SIC有较好的预测效能,t-PAIC、TM对脓毒症患者发生SIC的预后判断具有较高的价值。

Objective To investigate the value of novel coagulation and fibrinolysis markers in the diagnosis and prognosis of septic coagulation disease(SIC).Methods A total of 153 patients with sepsis admitted and treated in this hospital from July 2022 to March 2023 were retrospectively analyzed.According to the SIC diagnostic criteria issued by the International Society of Thrombosis and Hemostasis(ISTH)in 2017,the patients were divided into the SIC group(n=55)and the general sepsis group(the SA group,n=98).The basic data and follow up situation of the patients were collected.The multivariate logistic regression was adopted to analyze the influencing factors of SIC occurrence in the patients with sepsis.The receiver operating characteristic(ROC)curve was used to analyze the predictive efficiency of the related indicators for the SIC occurrence in the patients with sepsis.The included 66 patients with sepsis from April to July 2023conducted the verification.The Kaplan-Meier survival curve was used to analyze the survival situation of the patients.Results The acute physiological and chronic health status scoring system(APACHEⅡ)score,assessment of sequential organ failure(SOFA)score,prothrombin time(PT),PLT,D-dimer(D-D),thrombin antithrombin complex-Ⅲ(AT-Ⅲ),tissue plasminogen activator-plasminogen activator inhibitor-1 complex(t-PAIC),thrombomodulin(TM)had statistical differences between the two groups(P<0.05).The multivariate logistic regression analysis showed that PT,PLT,D-D,t-PAIC and TM were the independent influencing factors for the SIC occurrence in the patients with sepsis(P<0.05).The combined detection of PT,PLT,D-D,t-PAIC and TM could increase the predictive efficiency[area under the curve(AUC)=0.914].This model had good fitting goodness(χ^(2)=12.593,P=0.127);the verification group showed that it had good predictive efficiency(AUC=0.888),and this model had good fitting goodness(χ^(2)=7.996,P=0.333).The median overall survival time in the t-PAIC<19.27μg/mL group was longer than that in the t-PAIC≥19.27μg/mL group,which in the TM<16.11 TU/mL group was longer than that in the TM≥16.11 TU/mL group(P<0.05).Conclusion The model constructed based on the influencing factors has good predictive efficiency for the SIC occurrence in the patients with sepsis.t-PAIC and TM have high value for the prognosis judgment in the patients with sepsis.