摘要
目的研究凝血/纤溶指标和急诊社区获得性肺炎(CAP)病情严重程度的关系。方法回顾研究2010年8月至2013年8月我院急诊科96例CAP患者的临床资料。计算急诊脓毒症相关病死率(MEDS)评分,根据MEDS评分将患者分为中/高死亡风险组和低死亡风险组。分析患者年龄、性别及急诊首次静脉血白细胞(WBC)计数、血小板(PLT)计数、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)、纤维蛋白原(FIB)、D-二聚体(D-D)、谷丙转氨酶(ALT)、白蛋白(ALB)、总胆红素(TBIL)、尿素氮(BUN)、肌酐(CR)、脑钠肽(BNP)、血糖(GPT)与MEDS评分的关系。结果将单因素分析中P<0.1的指标(PT、APTT、INR、D-D)纳入logistic多因素回归分析,年龄(β=0.077,OR=1.080,P=0.005)、PLT(β=-0.011,OR=0.989,P=0.010)、BUN(β=0.213,OR=0.808,P=0.016)、D-D(β=0.190,OR=1.209,P=0.044)、INR(β=4.758,OR=116.469,P=0.042)为MEDS评分中/高死亡风险组的独立危险因素。将独立危险因素绘制受试者工作曲线(ROC),D-D、INR、年龄、BUN、PLT ROC曲线下面积分别为0.686、0.619、0.611、0.602、0.283。结论凝血/纤溶指标中除了D-D之外,INR也可以辅助评估急诊CAP病情严重程度。
Objective To investigate the relationship between the severity of patients with community-acquired pneumonia （CAP） in emergency department （ED） and coagulation/fibrinolysis index. Methods A total of 96 patients with CAP admitted in ED of the First Hospital of China Medical University from August 2010 to August 2013 were enrolled for the study and analyzed retrospectively. According to mortality in emergency department sepsis （MEDS） score, the patients were divided into high-moderate risk death group and low risk death group. In single-factor analysis, P 〈 0.1 was considered to be significant difference. These significanees were analyzed with multiple-factor analysis, and P 〈 0.05 was considered to have significant difference. Receiver-operating characteristic （ ROC ） curves was drawn, and ROC areas under the curve （ AUC ）, cut-off value, sen- sitivity, and specificity were calculated. Resolts The P 〈 0.1 factors were analyzed with logistic regression analysis, and the results were as fol- low：age （β =0.077, OR =1.080, P = 0.005） ,PLT （β =-0.011, OR =0.989,P = 0.010） ,BUN （β=0.213, OR =0.808, P = 0.016） ,D-D （β = 0.190, OR =1.209, P = 0.044）, INR （β=4.758, OR =116.469, P = 0.042） were considered the independent risk factors in high-moderate risk death group. AUCs ranked in descending order were those of BUN, age, INR and D-D. Conclusion Coagulation/fibrinolysis index, such as D-D and INR, can be indicators for assessing the degree of severity of patients with CAP in ED.
出处
《中国医科大学学报》
CAS
CSCD
北大核心
2016年第9期848-851,854,共5页
Journal of China Medical University
关键词
社区获得性肺炎
急诊脓毒症相关病死率
D-二聚体
国际标准化值
community-acquired pneumonia
mortality in emergency department sepsis
D-dimer
international normalized ratio
