血小板相关参数在脓毒症与脓毒性休克患者间变化差异及其与预后的相关性分析

摘要

Objective To study the variation of platelet-related parameters in non-severe sepsis and severe sepsis patients and the relationships between it and prognosis.Methods Chronic health evaluation (APACHE-II score), SOFA score and the emergence of MODS and other general information 100 patients with sepsis admitted to our hospital who hospitalized for acute physiology were recorded.Platelet-related parameters were detected within 24 h and 72 h after admission and according to their condition they were divided into Group A (patients with sepsis shock) and group B (sepsis).The relationship between the platelet-related parameters and prognosis were compared and analyzed, ROC curve was performed to analysis the prognostic value of platelet count (PLT), platelet volume distribution width (PDW) and mean platelet volume (MPV).Results Within 24 h of admission, PLT in A group was lower than that in group B (p<0.001), whereas the MPV (P=0.001) and PDW (p<0.001) in group A were higher than those in group B with significant difference.72 h after admission, the differences of PLT, MPV and PDW (p<0.001) were more obvious;24 h after admission, MPV (r=0.57, p<0.001) and PDW (r=0.54, p<0.001) in patients with sepsis were positively correlated with prognosis, and PLT count was negatively correlated with prognosis, and 72 h after admission each index associated with prognosis were enhanced, and PLT counts associated with prognosis significantly enhanced (r=-0.81, p<0.001).24 h after admission, PLT, MPV and PDW under the curve (AUC) were: 0.898, 0.833 and 0.856, 72 h after admission, PLT, MPV and PDW under the curve (AUC) were: 0.973, 0.951 and 0.944, and sensitive prognostic judgment degree of PLT was 94.82%, specificity 82.38%.Conclusion With septic patients are more severe, platelet-related parameters are changed, and 72 h after admission, platelet count may be a marker to predict prognosis.%目的 探讨血小板相关参数在脓毒症与脓毒性休克患者间变化差异以及其与预后的相关性.方法 选取100例收治的脓毒症患者,对患者入院时急性生理与慢性健康评分(APACHE-II评分)、序贯器官衰竭评估(SOFA)评分和出现多器官功能障碍综合征(MODS)等一般资料进行记录.分别检测入院24 h内和72 h后的血小板相关参数,根据其病情分为A组(脓毒症休克患者)和B组(脓毒症患者).对两组患者血小板相关参数及其与预后的相关性进行比较与分析,应用ROC曲线分析血小板计数(PLT)、血小板体积分布宽度(PDW)和血小板平均体积(MPV)对患者预后的判断价值.结果 ①入院24 h内,A组患者的PLT低于B组(p<0.001),而A组患者的MPV(p=0.001)和PDW(p<0.001)均高于B组,两组比较具有统计学差异,而于入院72 h后,两组的PLT(p<0.001)、MPV(p<0.001)和PDW(p<0.001)差异均更为明显;②入院24 h内,脓毒症患者的MPV(r=0.57,p<0.001)和PDW(r=0.54,p<0.001)均与预后呈正相关,而PLT计数则与预后呈负相关,而于入院72 h后,各个指标与预后的相关性均增强,且PLT计数与预后的相关性明显增强(r=-0.81,p<0.001);③入院24 h内,PLT、MPV和PDW曲线下面积分别是:0.898、0.833和0.856;入院72 h后,PLT、MPV和PDW曲线下面积分别是:0.973、0.951和0.944,且此时PLT判断预后的敏感度为94.82%,特异度为82.38%.结论 随着脓毒症患者的病情加重,血小板相关参数发生改变,而入院72 h后的血小板计数与预后存在一定的相关性,或许可有效地判断预后.