凝血新型分子标志物对脓毒血症合并弥散性血管内凝血的早期诊断及预后评估价值

Value of novel molecular markers of coagulation in early diagnosis and prognosis of sepsis complicated with diffuse intravascular coagulation

目的:研究脓毒症患者凝血新型指标在临床诊断和治疗中的应用。方法:选取2019年6月-2022年6月我院收治的脓毒血症患者102例为研究对象,根据中国弥散性血管内凝血诊断积分系统(CDSS),将其分为DIC组42例和非DIC组60例。检测两组凝血新型分子标志物[凝血酶-抗凝血酶原复合物(TAT)、血栓调节蛋白(TM)、组织纤溶酶原激活物-纤溶酶原激活抑制剂-1复合物(t-PAI-C)、纤溶酶-α2纤溶酶抑制物复合物(PIC)],根据90d生存情况,分为存活组、死亡组,采用受试者工作特征(ROC)曲线分析该指标诊断价值,并采用多因素Logistic回归分析该指标与患者预后的关系。结果:DIC组患者凝血新型分子标志物TAT、TM、t-PAI-C及PIC水平均高于非DIC组(P<0.05)。死亡组合并DIC比例及凝血新型分子标志物TAT、TM、t-PAI-C、PIC水平均高于存活组(P<0.05);两组性别、原发疾病、年龄、BMI比较(P>0.05)。ROC曲线分析显示,凝血新型分子标志物TAT、TM、t-PAI-C及PIC联合检测诊断脓毒血症合并DIC的曲线下面积AUC为0.918,敏感度为89.0%,特异度为84.2%,均高于TAT、TM、t-PAI-C及PIC单独检测。多因素Logistic回归分析显示,合并DIC比例及凝血新型分子标志物TAT、TM、t-PAI-C、PIC水平是影响脓毒血症患者预后的危险因素。结论:凝血新型分子标志物在诊断脓毒血症合并DIC中具有更高的敏感度和特异度,且可作为脓毒血症患者预后评估的有效指标。

Objective:To explore the use of new coagulation factors in the diagnosis and treatment of sepsis patients.Methods:102 sepsis patients hospitalised in our hospital from June 2019 to June 2022 were selected,and the patients were divided into 42 cases and 60 cases without DIC according to the Chinese DIC scoring criteria.In this study,the 90-day survival rate was proposed to be divided into survival and death groups by measuring thrombin-antithrombinogen complex(TAT),thrombomodulin(TM),and tissue plasminogen activatorplasminogen activation inhibitor(t-PAI-C,PIC),and applying ROC curves to the ROC curve for the survival and death groups by 90-day survival rate,as well as multifactorial logistic regression to explore its correlation with patient prognosis.Results:TAT,TM,t-PAI-C and PIC levels were significantly different in the DIC group compared to the non-DIC group(P<0.5).The incidence of mortality associated with DIC and the novel molecular coagulation markers TAT,TM,t-PAI-C and PIC was significantly higher in the DIC group compared with the survival group(P<0.05);There was no significant difference between the two groups with respect to gender,underlying diseases,age and body mass index.ROC curve analysis showed that the novel molecular coagulation markers TAT,TM,t-PAI-C and PIC in combination had a significant value for sepsis.The diagnostic value for DIC was 0.918,89.0%and 84.2%,respectively.Multivariate logistic regression analysis showed that the frequency of DIC,the novel coagulation factors TAT,TM,t-PAI-C and PIC were associated with the prognosis of sepsis in septic patients.Conclusion:The novel molecular marker of coagulation has higher sensitivity and specificity in the diagnosis of sepsis complicated with DIC,and can be used as an effective indicator to evaluate the prognosis of sepsis patients.