目的探讨血小板、凝血功能对合并2型糖尿病的脓毒症(sepsis patients with type 2 diabetes mellitus,T2DM-sepsis)患者发生急性肾损伤(acute kidney injury,AKI)的预测价值。方法选取2015年1月至2021年1月首都医科大学附属北京同仁医院...目的探讨血小板、凝血功能对合并2型糖尿病的脓毒症(sepsis patients with type 2 diabetes mellitus,T2DM-sepsis)患者发生急性肾损伤(acute kidney injury,AKI)的预测价值。方法选取2015年1月至2021年1月首都医科大学附属北京同仁医院T2DM-sepsis患者257例。根据T2DM-sepsis患者住院期间脓毒症发病7 d内是否发生AKI,将患者分为AKI组与非AKI组。收集两组患者一般资料和临床资料,采用多因素logistic回归方程分析T2DM-sepsis患者发生AKI的影响因素,并采用ROC曲线评估血小板、凝血功能对患者发生AKI的预测价值。结果257例患者中男146例、女111例,年龄32~101岁,平均(77.4±13.2)岁;发生AKI的患者34例(13.2%)。与非AKI组相比,AKI组的序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分、急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、血小板分布宽度(platelet distribution width,PDW)、血小板平均体积(mean platelet volume,MPV)、纤维蛋白原降解产物(fibrinogen degradation products,FDP)和D-二聚体(D-dimer,D-D)均较高,PLT较低,差异均有统计学意义(P<0.05)。多因素回归分析结果显示,SOFA评分越高(OR=1.300,95%CI:1.018~1.661,P=0.035)、PDW越高(OR=1.338,95%CI:1.122~1.596,P=0.001)的T2DM-sepsis患者发生AKI的风险越高。SOFA评分和PDW预测患者发生AKI的AUC分别为0.717(95%CI:0.619~0.815,P<0.001)和0.752(95%CI:0.655~0.848,P<0.001)。结论PDW值可作为T2DM-sepsis患者发生AKI风险的评估指标,临床上应特别关注PDW>12.25 fl的T2DM-sepsis患者的治疗和预后。展开更多
目的探讨中性粒细胞与淋巴细胞比率(neutrophil to lymphocyte ratio,NLR)、血小板(platelet,PLT)计数联合D-二聚体(D-dimer,D-D)对重症肺炎合并脓毒症患儿预后的预测价值。方法回顾性分析首都医科大学附属北京儿童医院急诊重症监护病房...目的探讨中性粒细胞与淋巴细胞比率(neutrophil to lymphocyte ratio,NLR)、血小板(platelet,PLT)计数联合D-二聚体(D-dimer,D-D)对重症肺炎合并脓毒症患儿预后的预测价值。方法回顾性分析首都医科大学附属北京儿童医院急诊重症监护病房(emergency intensive care unit,EICU)2018年1月~2023年1月收治的310例重症肺炎合并脓毒症患儿的临床资料,对所有患儿治疗出院后进行门诊复查或电话随访并根据相关标准对患儿预后进行评估,根据预后情况分为预后良好组(n=198)和预后不良组(n=112)。利用医院电子病历系统,收集全部患儿年龄、性别等基本临床资料,记录入院时患儿早期预警评分[慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序贯器官衰竭评分(sequential organ failure assessment,SOFA)],并收集诊断患儿入院24 h内的实验室指标。采用Logistic回归分析肺炎合并脓毒症患儿发生预后不良的相关影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析NLR、PLT计数、D-D预测重症肺炎合并脓毒症患儿预后的灵敏度、特异度、准确度。结果两组患儿年龄、性别差异无统计学意义(P>0.05)。预后不良组APACHEⅡ、SOFA评分显著高于预后良好组(P<0.05)。预后良好组NLR、D-D水平均低于预后不良组,PLT计数水平高于预后不良组(P<0.05)。将单因素分析的结果中P≤0.05的变量纳入多因素Logistic回归确定影响预后的独立危险因素。调整年龄、性别、APACHEⅡ评分等混杂因素,连续变量原值收入,结果表明,NLR、D-D水平是预后的保护因素(OR<1,P<0.05),PLT计数水平是预后的危险因素(OR>1,P<0.05)。ROC曲线分析结果显示,三项指标联合预测的曲线下面积(area under the curve,AUC)为0.949,灵敏度为94.95%,特异度为82.14%,准确度为90.32%,三者联合预测效能价值高。结论重症肺炎合并脓毒症患儿的外周血NLR、PLT计数、D-D水平显著升高,三项联合检测在预测患儿28 d后的预后中具有重要的价值。展开更多
目的:本文报道一例罕见的重症原发免疫性血小板减少症(ITP)患者治疗过程中合并EDTA、肝素钠、枸橼酸钠抗凝剂同时依赖性假性血小板减少的病例,分析与探讨其病因,为临床工作提供处理预案及经验指导。方法:通过静脉采血同时送EDTA-K2抗凝...目的:本文报道一例罕见的重症原发免疫性血小板减少症(ITP)患者治疗过程中合并EDTA、肝素钠、枸橼酸钠抗凝剂同时依赖性假性血小板减少的病例,分析与探讨其病因,为临床工作提供处理预案及经验指导。方法:通过静脉采血同时送EDTA-K2抗凝管、肝素钠抗凝管和枸橼酸钠(1:9)抗凝管至血细胞分析仪进行PLT计数,手指末梢血采血立即手工稀释计数法作为对比。回顾性分析该例临床资料,结合文献复习探讨其发生可能的原因。结果:该例ITP患者使用EDTA-K2抗凝管、肝素钠抗凝管、枸橼酸钠(1:9)抗凝管的PLT计数分别为6.00 × 109/L、9.00 × 109/L、7.00 × 109/L,手指末梢血校正手工稀释计数为PLT 32.00 × 109/L。患者ITP出血评分5分,重症ITP合并EDTA、肝素钠、枸橼酸钠抗凝剂同时依赖性假性血小板减少诊断明确,其原因可能与自身免疫性疾病及EDTA螯合、诱导血小板活化等机制相关,临床发生率极低,很容易误诊、漏诊,影响后续治疗,需要予以关注。结论:对于重症ITP患者治疗后血小板仍低的情况,除考虑治疗效果不理想外同时需要考虑合并EDTA、肝素钠、枸橼酸钠抗凝剂依赖性假性血小板减少的可能,需结合临床表现及时手工计数校正,可以减少临床误诊、漏诊。Objective: This article reports a rare case of severe primary immune thrombocytopenia (ITP) complicated with EDTA, sodium heparin, and sodium citrate anticoagulant-dependent pseudothrombocytopenia during treatment, shares and discusses its etiology, and provides treatment plans and experience guidance for clinical work. Methods: Venous blood was collected and sent to the blood cell analyzer for PLT counting in EDTA-K2 anticoagulant tubes, sodium heparin anticoagulant tubes, and sodium citrate (1:9) anticoagulant tubes. Finger-end blood sampling and immediate manual dilution counting were used as a comparison. The clinical data of this case were retrospectively analyzed, and the possible causes of its occurrence were discussed in combination with literature review. Results: The PLT counts of the ITP patient using EDTA-K2 anticoagulant tube, heparin sodium anticoagulant tube, and sodium citrate (1:9) anticoagulant tube were 6 × 109/L, 9 × 109/L, and 7 × 109/L, respectively. The PLT count of fingertip blood corrected for manual dilution was 32 × 109/L. The ITP bleeding score of the patient was 5 points, and the diagnosis of severe ITP combined with EDTA, heparin sodium, and sodium citrate anticoagulant-dependent pseudothrombocytopenia was clear. The cause may be related to autoimmune diseases and EDTA chelation, induction of platelet activation and other mechanisms. The clinical incidence is extremely low, and it is easy to misdiagnose and miss, which affects subsequent treatment and needs attention. Conclusion: For patients with severe ITP whose platelet count remains low after treatment, in addition to considering the unsatisfactory treatment effect, the possibility of EDTA, sodium heparin, and sodium citrate anticoagulant-dependent pseudothrombocytopenia should also be considered. Timely manual counting and correction should be performed based on clinical manifestations to reduce clinical misdiagnosis and missed diagnosis.展开更多
文摘目的探讨血小板、凝血功能对合并2型糖尿病的脓毒症(sepsis patients with type 2 diabetes mellitus,T2DM-sepsis)患者发生急性肾损伤(acute kidney injury,AKI)的预测价值。方法选取2015年1月至2021年1月首都医科大学附属北京同仁医院T2DM-sepsis患者257例。根据T2DM-sepsis患者住院期间脓毒症发病7 d内是否发生AKI,将患者分为AKI组与非AKI组。收集两组患者一般资料和临床资料,采用多因素logistic回归方程分析T2DM-sepsis患者发生AKI的影响因素,并采用ROC曲线评估血小板、凝血功能对患者发生AKI的预测价值。结果257例患者中男146例、女111例,年龄32~101岁,平均(77.4±13.2)岁;发生AKI的患者34例(13.2%)。与非AKI组相比,AKI组的序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分、急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、血小板分布宽度(platelet distribution width,PDW)、血小板平均体积(mean platelet volume,MPV)、纤维蛋白原降解产物(fibrinogen degradation products,FDP)和D-二聚体(D-dimer,D-D)均较高,PLT较低,差异均有统计学意义(P<0.05)。多因素回归分析结果显示,SOFA评分越高(OR=1.300,95%CI:1.018~1.661,P=0.035)、PDW越高(OR=1.338,95%CI:1.122~1.596,P=0.001)的T2DM-sepsis患者发生AKI的风险越高。SOFA评分和PDW预测患者发生AKI的AUC分别为0.717(95%CI:0.619~0.815,P<0.001)和0.752(95%CI:0.655~0.848,P<0.001)。结论PDW值可作为T2DM-sepsis患者发生AKI风险的评估指标,临床上应特别关注PDW>12.25 fl的T2DM-sepsis患者的治疗和预后。
文摘目的探讨中性粒细胞与淋巴细胞比率(neutrophil to lymphocyte ratio,NLR)、血小板(platelet,PLT)计数联合D-二聚体(D-dimer,D-D)对重症肺炎合并脓毒症患儿预后的预测价值。方法回顾性分析首都医科大学附属北京儿童医院急诊重症监护病房(emergency intensive care unit,EICU)2018年1月~2023年1月收治的310例重症肺炎合并脓毒症患儿的临床资料,对所有患儿治疗出院后进行门诊复查或电话随访并根据相关标准对患儿预后进行评估,根据预后情况分为预后良好组(n=198)和预后不良组(n=112)。利用医院电子病历系统,收集全部患儿年龄、性别等基本临床资料,记录入院时患儿早期预警评分[慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序贯器官衰竭评分(sequential organ failure assessment,SOFA)],并收集诊断患儿入院24 h内的实验室指标。采用Logistic回归分析肺炎合并脓毒症患儿发生预后不良的相关影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析NLR、PLT计数、D-D预测重症肺炎合并脓毒症患儿预后的灵敏度、特异度、准确度。结果两组患儿年龄、性别差异无统计学意义(P>0.05)。预后不良组APACHEⅡ、SOFA评分显著高于预后良好组(P<0.05)。预后良好组NLR、D-D水平均低于预后不良组,PLT计数水平高于预后不良组(P<0.05)。将单因素分析的结果中P≤0.05的变量纳入多因素Logistic回归确定影响预后的独立危险因素。调整年龄、性别、APACHEⅡ评分等混杂因素,连续变量原值收入,结果表明,NLR、D-D水平是预后的保护因素(OR<1,P<0.05),PLT计数水平是预后的危险因素(OR>1,P<0.05)。ROC曲线分析结果显示,三项指标联合预测的曲线下面积(area under the curve,AUC)为0.949,灵敏度为94.95%,特异度为82.14%,准确度为90.32%,三者联合预测效能价值高。结论重症肺炎合并脓毒症患儿的外周血NLR、PLT计数、D-D水平显著升高,三项联合检测在预测患儿28 d后的预后中具有重要的价值。
文摘目的:本文报道一例罕见的重症原发免疫性血小板减少症(ITP)患者治疗过程中合并EDTA、肝素钠、枸橼酸钠抗凝剂同时依赖性假性血小板减少的病例,分析与探讨其病因,为临床工作提供处理预案及经验指导。方法:通过静脉采血同时送EDTA-K2抗凝管、肝素钠抗凝管和枸橼酸钠(1:9)抗凝管至血细胞分析仪进行PLT计数,手指末梢血采血立即手工稀释计数法作为对比。回顾性分析该例临床资料,结合文献复习探讨其发生可能的原因。结果:该例ITP患者使用EDTA-K2抗凝管、肝素钠抗凝管、枸橼酸钠(1:9)抗凝管的PLT计数分别为6.00 × 109/L、9.00 × 109/L、7.00 × 109/L,手指末梢血校正手工稀释计数为PLT 32.00 × 109/L。患者ITP出血评分5分,重症ITP合并EDTA、肝素钠、枸橼酸钠抗凝剂同时依赖性假性血小板减少诊断明确,其原因可能与自身免疫性疾病及EDTA螯合、诱导血小板活化等机制相关,临床发生率极低,很容易误诊、漏诊,影响后续治疗,需要予以关注。结论:对于重症ITP患者治疗后血小板仍低的情况,除考虑治疗效果不理想外同时需要考虑合并EDTA、肝素钠、枸橼酸钠抗凝剂依赖性假性血小板减少的可能,需结合临床表现及时手工计数校正,可以减少临床误诊、漏诊。Objective: This article reports a rare case of severe primary immune thrombocytopenia (ITP) complicated with EDTA, sodium heparin, and sodium citrate anticoagulant-dependent pseudothrombocytopenia during treatment, shares and discusses its etiology, and provides treatment plans and experience guidance for clinical work. Methods: Venous blood was collected and sent to the blood cell analyzer for PLT counting in EDTA-K2 anticoagulant tubes, sodium heparin anticoagulant tubes, and sodium citrate (1:9) anticoagulant tubes. Finger-end blood sampling and immediate manual dilution counting were used as a comparison. The clinical data of this case were retrospectively analyzed, and the possible causes of its occurrence were discussed in combination with literature review. Results: The PLT counts of the ITP patient using EDTA-K2 anticoagulant tube, heparin sodium anticoagulant tube, and sodium citrate (1:9) anticoagulant tube were 6 × 109/L, 9 × 109/L, and 7 × 109/L, respectively. The PLT count of fingertip blood corrected for manual dilution was 32 × 109/L. The ITP bleeding score of the patient was 5 points, and the diagnosis of severe ITP combined with EDTA, heparin sodium, and sodium citrate anticoagulant-dependent pseudothrombocytopenia was clear. The cause may be related to autoimmune diseases and EDTA chelation, induction of platelet activation and other mechanisms. The clinical incidence is extremely low, and it is easy to misdiagnose and miss, which affects subsequent treatment and needs attention. Conclusion: For patients with severe ITP whose platelet count remains low after treatment, in addition to considering the unsatisfactory treatment effect, the possibility of EDTA, sodium heparin, and sodium citrate anticoagulant-dependent pseudothrombocytopenia should also be considered. Timely manual counting and correction should be performed based on clinical manifestations to reduce clinical misdiagnosis and missed diagnosis.
