摘要
目的系统分析2019新型冠状病毒肺炎(COVID-19)患者的凝血特征。方法计算机检索PubMed、Scopus、Web of Science、EMbase、中国知网数据库,搜集报道COVID-19凝血特征相关的文献,检索时限均为2020年1月1日至5月1日。由2名研究员独立筛选文献、提取数据并评价纳入研究的偏倚风险后,采用Stata12.0软件对不同疾病分型COVID-19患者的血小板计数、D-二聚体、凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、纤维蛋白原(FIB)进行Meta分析。结果共纳入39个回顾性研究,共计6994例COVID-19患者。Meta分析结果显示:(1)与重症患者相比,轻症患者的血小板计数较高[加权均值差(WMD)=20.11,95%CI 11.53~28.69,P<0.001],APTT(WMD=1.30,95%CI 0.31~2.30,P=0.01)更长,D-二聚体(WMD=-0.41,95%CI-0.58~-0.24,P<0.001)、FIB(WMD=-0.58,95%CI-0.76~-0.39,P<0.001)较低,凝血酶原时间(PT)(WMD=-0.51,95%CI-0.92~-0.10,P<0.001)更短;危重患者血小板计数较低(WMD=-14.75,95%CI-29.73~-0.23,P=0.044),D-二聚体较高(WMD=1.06,95%CI 0.65~1.47,P<0.001)。(2)与存活组相比,死亡组患者血小板计数较低(WMD=-36.40,95%CI-63.23~-9.58,P=0.008),D-二聚体较高(WMD=6.86,95%CI4.15~9.57,P<0.001),PT(WMD=1.37,95%CI0.73~2.02,P<0.001)更长。结论凝血功能紊乱在重症、危重症和死亡的COVID-19患者中较常见。血小板计数、D-二聚体和PT值与病情严重程度相关,可作为住院期间病情恶化的早期预警指标。
Objective To systematically analyse the blood coagulation features of coronavirus disease 2019(COVID-19)patients.Methods An electronic search in PubMed,Scopus,Web of Science,EMbase,and CNKI to collect studies related to the blood coagulation features of COVID-19 patients from 1 January 2020 to 1 May 2020.Two reviewers independently screened literatures,extracted data and assessed the risk of bias of included studies.Then,the platelet count,D-dimer value,prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen of patients with different types of diseases were analyzed by using Stata12.0 software.Results Thirty-nine retrospective studies involving 6994 COVID-19 patients were included.The results of meta-analysis showed that:(1)compared with severe group,the platelet count(Weighted mean difference;WMD=20.11,95%CI 11.53 to 28.69,P<0.001)and APTT(WMD=1.30,95%CI 0.31 to 2.30,P=0.01)were found to be higher while D-dimer(WMD=-0.41,95%CI-0.58 to-0.24,P<0.001),fibrinogen(WMD=-0.58,95%CI-0.76 to-0.39,P<0.001)and PT(WMD=-0.51,95%CI-0.92 to-0.10,P<0.001)were lower in mild group;the platelet count(WMD=-14.75,95%CI-29.73 to-0.23,P=0.044)was found to be lower while D-dimer(WMD=1.06,95%CI 0.65 to 1.47,P<0.001)was found to be higher in critical ill patients.(2)Compared with the survival group,the patients in death group displayed elevated levels of D-dimer(WMD=6.86,95%CI 4.15 to 9.57,P<0.001)and PT(WMD=1.37,95%CI 0.73 to 2.02,P<0.001)while platelet count(WMD=-36.40,95%CI-63.23 to-9.58,P=0.008)remained low.Conclusion Coagulation dysfunction was common in severe,critical ill and dead COVID-19 patients.Platelet count,D-dimer and PT levels were associated with the severity of the disease,and thus could be used as early warning indicators for the deterioration of the disease during hospitalization.
作者
朱洁云
钟枝梅
吉攀
庞杰龙
李红园
李柏成
张剑锋
Zhu Jieyun;Zhong Zhimei;Ji Pan;Pang Jielong;Li Hongyuan;Li Bocheng;Zhang Jianfeng(Department of Emergency,the Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,China)
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2021年第3期239-245,共7页
Chinese Journal of Laboratory Medicine
基金
国家自然科学基金(81960343)
广西重点研发计划防控新型冠状病毒感染肺炎疫情应急科技攻关专项(桂科AB20058002)
广西医学高层次骨干人才培养“139”计划(G201903027)。
