社区获得性肺炎凝血异常探讨
发布时间：2018-05-31 09:42
本文选题：社区获得性肺炎 + 凝血异常 ； 参考：《福建医科大学》2012年硕士论文
【摘要】：目的通过探讨社区获得性肺炎(community-acquired pneumonia, CAP)患者相关凝血指标变化,揭示凝血指标异常在CAP病情判断及预后评估方面的价值,以更好指导CAP临床诊断及治疗 方法回顾性分析厦门大学附属第一医院呼吸内科2010年6月至2011年5月收治的CAP患者385例,同期住院除外感染、肿瘤、外伤、血栓性疾病等因素的患者146例作为对照组,入院后4小时内立即取外周静脉血检测血细胞计数,磁珠法检测凝血四项,免疫比浊法检测D-二聚体,CAP患者同时进行肺炎严重度指数(pneumonia severity index, PSI)分级。通过上述指标对CAP患者进行病情判断及预后评估。评估终点为患者出院或死亡 结果(1)CAP患者与对照组之间年龄、性别分布差异无统计学意义(P0.05)。(2)与对照组比较,CAP患者反映凝血功能的指标血小板计数(PLT)升高(P0.05),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)、D-二聚体(D-D)显著升高(P0.001),凝血酶时间(TT)差异无统计学意义(P0.05)。中高危CAP患者(PSI分级Ⅳ-Ⅴ级)与低危CAP患者(PSI分级Ⅰ-Ⅲ级)对比,PT、TT、D-D显著升高(P0.001),PLT、APTT、Fib差异无统计学意义(P0.05)。(3)CAP组与对照组比较,PLT、PT、APTT、Fib、D-D异常率差异有统计学意义(P0.001),TT异常率差异无统计学意义(P0.05)。中高危CAP组与低危CAP组比较,PLT、PT、D-D异常率差异有统计学意义(P0.05),TT、APTT、Fib异常率差异无统计学意义(P0.05)。(4)中高危CAP患者与低危CAP患者对比,D-D显著升高(F=38.441,P0.001),PLT异常率差异无统计学意义(P0.05)CAP患者中,D-D升高与PSI分层存在等级相关性(r=0.798,P0.001),PLT异常率与PSI分层无关。(5)CAP患者中合并呼吸衰竭者与无呼吸衰竭者对比,D-D显著升高(P0.001),PLT异常率差异无统计学意义(P0.05)(6)CAP患者中死亡组与生存组对比,D-D显著升高(P0.001),PLT异常率差异有统计学意义(P0.05)。(7)使用ROC曲线分析D-D、PSI及PLT异常率对CAP患者病死率的预测能力,三者曲线下面积：D-D为0.962,PSI为0.906，PLT为0.583，D-D及PSI二者对死亡的预测准确性高（P㩳0.001），D-D具有较好的敏感性和特异性，其敏感性优于特异性。PLT异常对病死率预测准确性欠佳（P㧐0.05）。 结论1、CAP患者存在PLT计数、PT、APTT、Fib、D-D多个凝血指标异常；2、CAP患者血浆D-D显著升高，且与病情严重程度及病死率呈正相关，，血浆D-D可作为CAP病情评估及预测死亡的良好指标。
[Abstract]:Objective to explore the changes of coagulation indexes in community-acquired pneumonias (Caps) patients, and to reveal the value of abnormal coagulation indexes in the diagnosis and prognosis evaluation of CAP, so as to guide the clinical diagnosis and treatment of CAP. Methods 385 patients with CAP from June 2010 to May 2011 in the Department of Respiratory Medicine affiliated to Xiamen University were retrospectively analyzed. 146 patients with infection, tumor, trauma, thrombotic disease and other factors in the same period were taken as the control group. Within 4 hours after admission, peripheral venous blood was collected immediately to detect blood cell count, magnetic beads method was used to detect four items of coagulation, and immunoturbidimetric method was used to detect pneumonia severity index and severity index, PSI) grade in patients with D- dimer CAP. To evaluate the condition and prognosis of CAP patients by the above indexes. Assessment endpoint: discharge or death Results the age of patients with CAP was compared with that of control group. There was no significant difference in sex distribution (P 0.05N. P < 0.05) compared with the control group, the platelet count (PLT) in CAP patients was higher than that in the control group (P 0.05), prothrombin time (PTT), activated partial thromboplastin time (APTT), fibrinogen (Fib) D- dimer (D-D) were significantly higher in CAP patients than in the control group. There was no significant difference in thrombin time (TTT). PSI grade 鈪
本文编号：1959183
本文链接：https://www.wllwen.com/yixuelunwen/huxijib/1959183.html
最近更新
教材专著
