| 摘要: |
| ［摘要］ 目的 分析纤维蛋白原降解产物（FDP）、D-二聚体（D-D）联合血小板（PLT）预测创伤性凝血病（TIC）患者生存预后的效能。方法 回顾性收集2020年2月至2023年2月昆明市第一人民医院收治的182例创伤患者的临床资料，根据TIC发生情况将其分为TIC组（85例）和非TIC组（97例）。比较两组临床资料，采用多因素logistic回归分析探讨TIC患者入院时FDP、D-D、PLT水平对入院后30 d内死亡发生的影响，并采用受试者工作特征（ROC）曲线分析探讨上述指标的预测效能。结果 TIC组创伤严重程度评分（ISS)、凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、凝血酶原时间比值（PTR）、国际标准化比值（INR）水平以及死亡发生率高于非TIC组，纤维蛋白原（Fib）、PLT、血红蛋白（Hb）水平低于非TIC组，差异有统计学意义（P<0.05）。TIC患者入院后30 d内存活59例，死亡26例。存活组FDP、D-D水平显著低于死亡组（P<0.05），PLT水平显著高于死亡组（P<0.05），两组Fib水平比较差异无统计学意义（P>0.05）。经调整年龄、性别、住院时间、ISS因素后，多因素logistic回归分析结果显示，FDP［OR(95%CI)=1.021（1.007～1.036)］、D-D［OR(95%CI)=1.087（1.027～1.250)］水平升高是促进TIC患者发生死亡的危险因素（P<0.05），PLT［OR(95%CI)=0.990（0.983～0.997）］水平升高是抑制TIC患者发生死亡的保护因素（P<0.05）。ROC曲线分析结果显示，FDP、D-D、PLT可有效预测TIC患者入院30 d内死亡（P<0.05），且三项指标联合的预测效能更高［AUC(95%CI)=0.823(0.720～0.925)，P<0.001］。结论 入院时检测FDP、D-D、PLT指标有助于评估TIC患者的生存预后情况，值得临床医师关注。 |
| 关键词: 创伤性凝血病 生存预后 纤维蛋白原降解产物 D-二聚体 血小板 |
| DOI：10.3969/j.issn.1674-3806.2024.05.11 |
| 分类号:R 641 |
| 基金项目:云南省科技厅科技计划项目（编号：202301AY070001-097）；云南省科技厅重大科技专项计划项目（编号：202302AA310018） |
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| Analysis on the efficacy of FDP and D-D combined with PLT in predicting survival prognosis of patients with trauma-induced coagulopathy |
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WANG Yaxin, QIAN jing, YANG Wendi, LANG Di, MA Yongxin, ZHANG Hongwei, LI Haisheng, ZHAO Xiaoli
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Department of Laboratory Medicine, the First People′s Hospital of Kunming, Yunnan 650031, China
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| Abstract: |
| ［Abstract］ Objective To analyze the the efficacy of fibrinogen degradation products(FDP) and D-dimer(D-D) combined with platelet(PLT) in predicting survival prognosis of patients with trauma-induced coagulopathy(TIC). Methods The clinical data of 182 trauma patients admitted to the First Hospital of Kunming from February 2020 to February 2023 were retrospectively collected. According to the occurrence of TIC, the patients were divided into TIC group(85 cases) and non-TIC group(97 cases). The clinical data were compared between the two groups, and the effects of FDP, D-D and PLT levels in the TIC patients at admission on the occurrence of death within 30 days after admission were explored by using multivariate logistic regression analysis, and the predictive efficacy of the above indicators was analyzed by using receiver operating characteristic(ROC) curve. Results The levels of injury severity score(ISS), prothrombin time(PT), activated partial thromboplastin time(APTT), prothrombin time ratio(PTR), international normalized ratio(INR) and death rate in the TIC group were higher than those in the non-TIC group, while the levels of fibrinogen(Fib), PLT and hemoglobin(Hb) in the TIC group were lower than those in the non-TIC group, and the differences were statistically significant(P<0.05). Among the TIC patients, 59 cases survived and 26 cases died within 30 days after admission. The FDP and D-D levels in the survival group were significantly lower than those in the death group(P<0.05), and the PLT level in the survival group was significantly higher than that in the death group(P<0.05). There was no statistically significant difference in Fib level between the two groups(P>0.05). After adjusting the factors of age, gender, length of hospital stay and ISS, the results of multivariate logistic regression analysis showed that the elevated levels of FDP［OR(95%CI)=1.021(1.007-1.036)］ and D-D［OR(95%CI)=1.087(1.027-1.250)］ were risk factors for promoting death in the patients(P<0.05), and the elevated level of PLT［OR(95%CI)=0.990(0.983-0.997)］ was a protective factor for inhibiting death in the patients(P<0.05). The results of ROC curve analysis showed that FDP, D-D and PLT could effectively predict the occurrence of death within 30 days after admission in the TIC patients(P<0.05), and the predictive efficacy of combining these three indicators was higher［AUC(95%CI)=0.823(0.720-0.925), P<0.001］. Conclusion Detection of FDP, D-D and PLT indicators at admission is helpful to evaluate the survival prognosis of TIC patients, which is worth the attention of clinical physicians. |
| Key words: Trauma-induced coagulopathy(TIC) Survival prognosis Fibrinogen degradation products(FDP) D-dimer(D-D) Platelet(PLT) |
