新型冠状病毒肺炎所致凝血功能障碍及其对预后的影响
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(南京医科大学第二附属医院心血管内科,南京 210000)

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R51

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Coagulation dysfunction and its effect on prognosis in patients with coronavirus disease 2019 pneumonia
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(Department of Cardiology, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China)

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    摘要:

    目的 分析新型冠状病毒肺炎(COVID-19)感染患者血浆D-二聚体、血浆纤维蛋白(原)降解产物(FDPs)等凝血指标的特点,并探讨其对患者病情的预测价值。方法 收集南京医科大学第二附属医院自2022年12月至2023年1月收治的COVID-19感染患者100例,分为轻型组(n=29例),中型组(n=40例)及重型/危重型组(n=31例)。记录患者血浆D-二聚体、FDPs等凝血相关指标水平,分析3组患者凝血指标水平的特点。采用SPSS 27.0软件进行数据分析。根据数据类型,组间比较分别采用LSD-t检验、方差分析、χ2检验、Kruskal-Wallis检验及Bonfferoni校正检验。采用受试者工作特征(ROC)曲线评价FDPs、D-二聚体、年龄及联合分析对预测COVID-19感染患者病死的诊断价值。结果 重型/危重型组患者高龄、合并基础疾病比例及死亡率高于轻型组、中型组,差异有统计学意义(P<0.05);中型组患者血浆FDPs水平、重型/危重型组患者血浆FDPs、D-二聚体水平均高于轻型组,差异有统计学意义(P<0.05);FDPs、D-二聚体、年龄、FDPs与D-二聚体两项联合分析、FDPs与D-二聚体、年龄三项联合分析的ROC曲线下面积分别为0.785(95%CI 0.645~0.926;P<0.01)、0.811(95%CI 0.691~0.03;P<0.01)、0.725(95%CI 0.558~0.891;P<0.05)、0.766(95%CI 0.581~0.951;P<0.05)、0.875(95%CI 0.789~0.962;P<0.01),灵敏度分别为90.9%、100.0%、72.7%、81.8%、100.0%,特异度分别为61.8%、50.6%、78.7%、71.9%、62.9%。结论 COVID-19感染患者血浆D-二聚体、FDPs水平明显升高,且合并高龄对COVID-19感染疾病严重程度及不良预后具有重要预测价值。

    Abstract:

    Objective To analyze the characteristics of plasma D-dimer, fibrin degradation products (FDPs) and other coagulation indices in patients with coronavirus disease 2019 (COVID-19) pneumonia and explore their predictive value for patient′s condition. Methods A total of 100 patients with COVID-19 pneumonia admitted to our hospital from December 7,2022 to January 28,2023 were enrolled and then divided into mild (n=29), moderate (n=40), and severe/critical infection (n=31) groups. Their plasma D-dimer, FDPs and other coagulation indices were recorded, and the characteristics of coagulation indices were analyzed in the three groups. SPSS statistics 27.0 was used for statistical analysis. LSD-t test, Fisher exact test, Kruskal-Wallis test, χ2test or Bonferroni calibration test were employed for intergroup comparison depending on data type. Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of FDPs, D-dimer, age, and their combination in predicting mortality in the COVID-19 infected patients. Results Larger proportions of older age and comorbidities and higher mortality were observed in the severe/critical groups than the mild and moderate groups (P<0.05). Plasma FDPs level in the moderate group and plasma FDPs and D-dimer levels in the severe/critical group were significantly higher than those in the mild group (P<0.05). The area under the curve (AUC) of FDPs, D-dimer, age, combined FDPs and D-dimer, and combination of FDPs, D-dimer and age in predicting mortality in the COVID-19 infected patients was 0.785 (95%CI 0.645-0.926; P<0.01), 0.811 (95%CI 0.691-0.03; P<0.01), 0.725 (95%CI 0.558-0.891; P<0.05), 0.766 (95%CI 0.581-0.951; P<0.05) and 0.875 (95%CI 0.789-0.962; P<0.01), respectively, and the sensitivity was 90.9%, 100.0%, 72.7%, 81.8% and 100.0%, and the specificity was 61.8%, 50.6%, 78.7%, 71.9% and 62.9%, respectively. Conclusion Plasma D-dimer and FDPs levels are significantly increased in COVID-19 patients. The two indicators combined with advanced age have an important predictive value for the severity and poor prognosis of COVID-19.

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孙玉,郭守玉,龙明智.新型冠状病毒肺炎所致凝血功能障碍及其对预后的影响[J].中华老年多器官疾病杂志,2024,23(4):291~294

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  • 收稿日期:2023-06-05
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  • 在线发布日期: 2024-04-23
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