D-二聚体、组织型纤溶酶原激活物、纤溶酶原激活物抑制剂-1及凝血功能联合评估脓毒症休克患者预后的价值

The prognostic value of D-dimer andtissue plasminogen activator and plasminogen activator inhibitor-1 and coagulation function in patients with septic shock

目的探究D-二聚体(D-dimer,D-D)、组织型纤溶酶原激活物(tissue plasminogen activator,t-PA)、纤溶酶原激活物抑制剂-1(plasminogen activator inhibitor 1,PAI-1)及凝血功能联合评估脓毒症休克患者预后的价值。方法选取2020年1月至2022年1月赣州市人民医院收治的60例脓毒症患者作为研究对象,根据患者病情严重程度分为非休克组(n=45)与休克组(n=15),并根据休克组患者28 d的生存结局分为存活组(n=11)与死亡组(n=4)。比较非休克组与休克组、死亡组与存活组D-D、t-PA、PAI-1水平、凝血功能[凝血酶时间(thrombin time,TT)、凝血酶原时间(prothrombin time,PT)、纤维蛋白原(fibrinogen,Fg)、活化部分凝血活酶时间(activated partial thrombin time,APTT)]、急性生理学及慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluation scoring system,APACHEⅡ)、序贯器官衰竭估计(sequential organ failure assessment,SOFA)评分;采用Pearson相关性分析血清D-D、t-PA、PAI-1水平、血功能指标与SOFA评分、APACHEⅡ评分的相关性;采用多因素Logistic回归分析脓毒症休克患者预后差的影响因素。结果休克组血清D-D、t-PA、PAI-1、Fg水平和APACHEⅡ、SOFA评分均高于非休克组,TT、PT、APTT均长于非休克组,差异有统计学意义(P<0.05)。死亡组血清D-D、t-PA、PAI-1、Fg水平和APACHEⅡ、SOFA评分均高于存活组,TT、PT、APTT均长于存活组,差异有统计学意义(P<0.05)。Pearson相关分析结果显示,脓毒症患者血清D-D、t-PA、PAI-1水平及TT、PT、APTT、血清Fg水平均与SOFA评分、APACHEⅡ评分呈正相关(r>0,P<0.05)。多因素Logistic回归分析结果显示,血清D-D、Fg水平及SOFA、APACHEⅡ评分高及PT、APTT长是脓毒症休克患者预后差的独立危险因素(P<0.05)。结论D-D、t-PA、PAI-1及凝血功能指标均可作为脓毒性患者病情评估和预后判定的参考依据。

Objective To investigate the combined evaluated value of D-dimer(D-D),tissue plasminogen activator(t-PA),plasminogen activator inhibitor-1(PAI-1)and coagulation function on prognosis in patients with septic shock.Methods A total of 60 patients with sepsis admitted to Ganzhou People's Hospital from January 2020 to January 2022 were selected as the study subjects,and they were divided into the non-shock group(n=45)and the shock group(n=15)according to the disease severity of patients,the patients in the shock group were classified into the survival group(n=11)and the death group(n=4)by means of 28-day survival outcome.The levels of D-D,t-PA and PAI-1,coagulation function(thrombin time[TT],prothrombin time[PT],fibrinogen[Fg],activated partial thromboplastin time[APTT]),acute physiology and chronic health evaluation scoring system(APACHEⅡ)score and sequential organ failure assessment(SOFA)score were compared between the non-shock group and the shock group,and between the death group and the survival group;Pearson correlation analysis was used to analyze the correlation between serum D-D,t-PA,PAI1,coagulation function indexes and SOFA score,APACHEⅡscore;multivariate Logistic regression analysis was used to analyze the influencing factors of poor prognosisinpatients with septic shock.Results The serum levels of D-D,t-PA,PAI-1 and Fg and scores of APACHEⅡand SOFA in the shock group were higher than those in the non-shock group,and TT,PT and APTT were longer than those in the non-shock group,and the differences were statistically significant(P<0.05).The levels of serum D-D,t-PA,PAI-1 and Fg,APACHEⅡand SOFA scores in the death group were higher than those in the survival group,and TT,PT and APTT were longer than those in the survival group,and the differences were statistically significant(P<0.05).Pearson correlation analysis showed that serum D-D,t-PA,PAI-1,PT,APT and serum Fg were positively correlated with SOFA and APACHEⅡscores in septic shock patients(r>0,P<0.05).Multivariate Logistic regression analysis showed that high serum D-D and Fg levels,SOFA and APACHEⅡscores,long PT and APTT were independent risk factors for poor prognosis in septic shock patients(P<0.05).Conclusion D-D,t-PA,PAI-1 and coagulation function indexes can be used as reference for the disease assessment and prognosis judgement of septic shock patients.