血小板容积指数与变化率对重症SFTS患者预后的评估价值

Prognostic prediction value of platelet volume index and platelet change rate for severe SFTS cases

目的 探讨血小板容积指数(platelet volume index,PVI)、血小板变化率(platelet change rate,△ PLT3d%)对重症发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)患者预后的评估价值.方法 选取2020年1月至2024年5月收住重症医学科的重症SFTS患者,记录患者的性别、年龄和入院72 h内血常规、肝肾功能、凝血功能等指标,计算急性生理学与慢性健康状况 Ⅱ(acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)评分.根据患者 28 d预后分为死亡组、存活组,比较两组患者上述指标的差异.结果 本研究共纳入SFTS患者27例,存活组11例,死亡组16例,病死率59.3%.存活组患者APACHE Ⅱ评分、血小板分布宽度(platelet distribution width,PDW)、平均血小板体积(mean platelet volume,MPV)、谷丙转氨酶、谷草转氨酶、凝血酶原时间和活化部分凝血酶原时间均低于死亡组,存活组患者血小板计数(platelet count,PLT)、△PLT3d%均高于死亡组,差异有统计学意义(P<0.05);MPV与APACHE Ⅱ评分呈正相关(r=0.620,P<0.05),PLT 与 APACHE Ⅱ 评分呈负相关(r=-0.719,P<0.001).受试者工作特征(receiver operating characteristic,ROC)曲线分析结果显 示,PLT、PDW、MPV、△ PLT3d%、APACHE Ⅱ评分对SFTS患者的预后均有一定的预测价值.MPV的预测价值最大(AUC=0.855,95%CI:0.714~0.997),敏感度 68.8%,特异度 90.9%,结论 PVI、△PLT3d%与 SFTS 患者病情严重程度存在关联,对疾病预后有较好的预测价值.

Objective To investigate the predicting value of platelet volume index(PVI)and platelet change rate(△PLT3d%)for the prognosis of patients with severe fever with thrombocytopenia syndrome(SFTS).Methods Severe SFTS cases admitted to the Department of Critical Care Medicine from January 2023 to May 2024 were selected.Gender,age and the results of blood routine test,liver and kidney function,coagulation function and other indexes within 72 hours after admission were recorded.The acute physiology and chronic health evaluationⅡ(APACHEⅡ)score was calculated.The patients were divided into death group and survival group according to the prognosis within 28 days.The differences of the above indicators between the two groups were compared.Results A total of 27 patients with SFTS were included in this study,including 11 survivors and 16 deaths,with a case fatality rate of 59.3%.The APACHEⅡscore,platelet distribution width(PDW),mean platelet volume(MPV),glutamic pyruvic transaminase(ALT),glutamic oxalacetic transaminase(AST),prothrombin time(PT)and activated partial prothrombin time(APTT)in survival group were lower than those in death group,while platelet count(PLT)and△PLT3d%in survival group were higher than those in death group.The differences were all statistical significant(P<0.05).The MPV and APACHEⅡscores were positively correlated(r=0.620,P<0.05)while PLT and APACHEⅡscores were negatively correlated(r=-0.719,P<0.001).Receiver operating characteristic(ROC)curve analysis showed that PLT,PDW,MPV,△PLT3d%and APACHEⅡscores had predictive values for the prognosis of patients with SFTS.MPV had the highest predictive value(AUC=0.855,95%CI:0.714-0.997),with a sensitivity of 68.8%and a specificity of 90.9%.Conclusions PVI and△PLT3d%are associated with the severity of SFTS cases and have good prognostic prediction value.