摘要
背景重症肺炎是临床常见危重症,患者常伴有严重低血压、低氧血症等症状。凝血功能在疾病的发生、发展中具有重要作用,但传统凝血功能检测难以全面评估患者机体凝血状态,而纤溶酶原活化剂(PA)、纤溶酶原活化抑制剂1(PAI-1)较传统凝血功能检测更便捷、更准确,可为临床评估重症肺炎患者凝血状态提供更全面的信息。目的分析重症肺炎患者血浆PA、PAI-1水平变化及其临床意义。方法选取2016年10月—2019年4月河北省老年病医院收治的重症肺炎患者122例为研究组,其中中青年(20~59岁)47例,老年(≥60岁)75例。另选取本院同期体检健康人群122例为对照组。分别比较两组受试者及研究组不同年龄患者血浆u-PA、t-PA、PAI-1、C反应蛋白(CRP)、降钙素原(PCT)水平;采用Pearson相关分析探讨重症肺炎患者血浆u-PA、t-PA、PAI-1水平与CRP、PCT水平的相关性。随访1个月,比较不同预后老年重症肺炎患者血浆u-PA、t-PA、PAI-1、CPR、PCT水平。绘制受试者工作特征曲线(ROC曲线)以评估血浆u-PA、t-PA、PAI-1水平及其联合对老年重症肺炎患者预后的预测价值。结果研究组血浆u-PA、t-PA、PAI-1、CRP、PCT水平高于对照组(P<0.05)。老年重症肺炎患者血浆u-PA、t-PA、PAI-1、CRP、PCT水平高于中青年重症肺炎患者(P<0.05)。Pearson相关分析结果显示,重症肺炎患者血浆u-PA、t-PA、PAI-1水平与CRP、PCT水平均呈正相关(P<0.05)。随访1个月,老年重症肺炎患者死亡23例,生存52例。老年重症肺炎死亡患者血浆u-PA、t-PA、PAI-1、CRP、PCT水平高于生存患者(P<0.05)。ROC曲线分析结果显示,血浆u-PA、t-PA、PAI-1水平联合预测老年重症肺炎患者预后的曲线下面积(AUC)均大于单一指标对应的AUC(P<0.05)。结论血浆u-PA、t-PA、PAI-1水平随重症肺炎患者年龄的增加及病情严重程度的加重而升高,可提示机体凝血、纤溶功能紊乱及感染程度,而三者联合对老年重症肺炎患者预后具有较高的预测价值。
Background Severe pneumonia is a common clinical disease,patients often accompanied by severe hypotension and hypoxemia,and coagulation plays an important role in the occurrence and development of diseases.However,the traditional coagulation function test is difficult to comprehensively evaluate the coagulation state of the body,plasminogen activator(PA)and plasminogen activation inhibitor-1(PAI-1)are more convenient and accurate than traditional coagulation function test,and can provide more comprehensive information for clinical evaluation of coagulation status of patients with severe pneumonia.Objective To investigate the changes and clinical significance of PA and PAI-1 in patients with severe pneumonia.Methods 122 patients with severe pneumonia in Hebei Geriatric Hospital from October 2016 to April 2019 were selected as the study group,of which 47 cases were young and middle-aged(20-59 years old)patients,75 cases were elderly(≥60years old)patients,and 122 healthy physical examinations in the same period were selected as the control group.The plasma levels of u-PA,t-PA,PAI-1,C-reactive protein(CRP)and procalcitonin(PCT)were compared between the control group and study group,and between the different ages of patients in study group;the correlation between plasma levels of u-PA,t-PA,PAI-1 and CRP,PCT in patients with severe pneumonia were analysed by Pearson correlation analyse.After 1 month's followup,the plasma levels of u-PA,t-PA,PAI-1,CPR,PCT were compared between different prognosis of elderly patients with severe pneumonia.ROC curve was drawn to evaluate predictive value of plasma levels of u-PA,t-PA,PAI-1 in prognosis of elderly patients with severe pneumonia.Results The plasma levels of u-PA,t-PA,PAI-1,CRP and PCT in study group were higher than those in control group(P<0.05).The plasma levels of u-PA,t-PA,PAI-1,CRP and PCT in elderly patients with severe pneumonia were higher those in young and middle-aged patients(P<0.05).Pearson correlation analyse showed that,the plasma levels of u-PA,t-PA,PAI-1 were positively correlation with plasma levels of CRP,PCT in patients with severe pneumonia(P<0.05).After 1 month's followed-up,among elderly patients with severe pneumonia,23 patients died,and 52 patients survived.The plasma levels of u-PA,t-PA,PAI-1,CRP and PCT in dead elderly patients with severe pneumonia were higher than those in survival patients(P<0.05).ROC curve results showed that AUC of combination of plasma levels of u-PA,t-PA,PAI-1 was bigger than that of each index alone in elderly patients with severe pneumonia(P<0.05).Conclusion Plasma levels of u-PA,t-PA,PAI-1 increase with the age and severity of severe pneumonia patients,and it is suggested that the coagulation and fibrinolysis function of the body is disordered and infection degree,and the combined detection of plasma levels of u-PA,t-PA,PAI-1 have a high predictive value for the prognosis of elderly patients with severe pneumonia.
作者
许倩
常兴芳
吴文锋
路康
XU Qian;CHANG Xingfang;WU Wenfeng;LU Kang(Department of Clinical Laboratory,Hebei Geriatric Hospital,Shijiazhuang 050000,China;Department of Clinical Laboratory,the Second Outpatient Department of Directly under the Authority in Hebei Province,Shijiazhuang 050000,China)
出处
《实用心脑肺血管病杂志》
2020年第10期79-83,共5页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
河北省2020年度医学科学研究课题计划项目(20200702)。
