Evaluation value of calcitonin original and blood coagulation function for the prognosis of patients with sepsis
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摘要:
目的 探讨脓毒血症患者的凝血功能状况变化及降钙素原变化趋势与预后的相关性。 方法 选取本院2015年1月~2016年6月入住急诊ICU的脓毒血症患者作为研究对象，按照预后分为死亡组和存活组。分别检测两组患者血浆凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、纤维蛋白原和血清降钙素原水平。 结果 死亡组的PCT和凝血功能水平均高于存活组（P<0.05），ROC曲线显示血清降钙素原最佳截断点为34.24时，曲线下面积（AUG）为93.4，敏感度87.1%，特异度93.1%；血浆凝血酶原时间最佳截断点为14.75时，AUG为72.5，敏感度54.8%，特异度93.1%；国际标准化比值最佳截断点为1.31时，AUG为72，敏感度48.4%，特异度89.7%；活化部分凝血活酶时间最佳截断点为39.20时，AUG为71.7，敏感度67.7%，特异度86.2%；Fbg最佳截断点为3.31时，AUG为90.3，敏感度58.6%，特异度93.1%。 结论 降钙素原和凝血功能与脓毒血症病情密切相关，可作为监测病情及预后的重要指标。 Abstract:Objective To investigate the blood coagulation function in patients with sepsis and the correlation of procalcitonin change trend with prognosis. Methods The patients with sepsis in emergency ICU of our hospital in January 2015-June 2016 were choosed as research object. Patients were divided into death group and alive group according to prognosis. Plasma prothrombin time (PT), activated partial clotting enzyme live time (APTT), thrombin time (TT), fibrinogen (FIB) and serum calcitonin (PCT) level of 2 groups were detected. Results The difference of 2 groups was significantly(P<0.05). ROC curve showed the best cut-off point of PCT was 34.24, with the area under the curve (AUG) of 93.4, sensitivity of 87.1%, specific degree of 93.1%; best cut-off point of PT was 14.75, with AUG of 72.5, sensitivity of 54.8%, the specific degree of 93.1%; best cut-off point of INR was 1.305, with AUG of 72, sensitivity of 48.4%, the specific degree of 89.7%; best cut-off point of APTT was 39.2, with AUG of 71.7, sensitivity of 67.7%, the specific degree of 86.2%; best cut-off point of Fbg was 3.315, with AUG of 90.3, sensitivity of 58.6% and specific degree of 93.1%. Conclusion Procalcitonin and blood coagulation function are closely related to the severity of sepsis. They can be used as an important index of disease monitoring and prognosis. -
Key words:
- procalcitonin /
- blood coagulation function /
- sepsis /
- prognosis
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表 1 脓毒血症两组不同预后指标的比较（
$\, \overline{{x}}{{±}}{{s}}$ ）分组 PCT（ng/mL） PT（s） INR APTT（s） TT（s） Fbg（g/L） 死亡组 76.9±27.3 18.2±14.2 1.5±1.3 45.5±15.8 14.7±5.8 3.4±1.3 存活组 15.7±10.7 10.9±12.5 0.9±1.1 34.0±12.2 13.9±6.1 4.06±5.8 P 0.000 0.003 0.003 0.004 0.069 0.012 PCT: 血清降钙素原; PT: 血浆凝血酶原时间; INR: 国际标准化比值; APTT: 活化部分凝血活酶时间; TT: 凝血酶时间; Fbg: 空腹血糖. 
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表 2 受试者ROC曲线在脓毒血症预测价值的比较（%）
分组 PCT（ng/mL） PT（s） INR APTT（s） TT（s） Fbg（g/L） 死亡组 76.9±27.3 18.2±14.2 1.5±1.3 45.5±15.8 14.7±5.8 3.4±1.3 存活组 15.7±10.7 10.9±12.5 0.9±1.1 34.0±12.2 13.9±6.1 4.06±5.8 P 0.000 0.003 0.003 0.004 0.069 0.012 PCT: 血清降钙素原; PT: 血浆凝血酶原时间; INR: 国际标准化比值; APTT: 活化部分凝血活酶时间; TT: 凝血酶时间; Fbg: 空腹血糖.
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