中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
24期
1925-1929
,共5页
徐悦利%张阳%姜锋%郑洪飞%张艳敏%庞桂芬%杨林瀛%张庆
徐悅利%張暘%薑鋒%鄭洪飛%張豔敏%龐桂芬%楊林瀛%張慶
서열리%장양%강봉%정홍비%장염민%방계분%양림영%장경
肺炎%社区获得性感染%疾病严重程度指数%凝血%纤溶
肺炎%社區穫得性感染%疾病嚴重程度指數%凝血%纖溶
폐염%사구획득성감염%질병엄중정도지수%응혈%섬용
Pneumonia%Community-acquired infections%Severity of illness index%Coagulation%Fibrinolysis
目的 比较不同严重程度社区获得性肺炎(CAP)患者凝血及纤溶相关指标.方法 连续选取2013年7月至2014年6月于承德医学院附属医院呼吸科住院的107例CAP患者作为肺炎组,同期52名门诊健康体检者作为对照组,检测入选者血常规、凝血纤溶、降钙素原及C-反应蛋白(CRP)等指标.将107例患者根据肺炎严重度指数(PSI)分为低风险组、中高风险组,观察不同分组间上述指标的差异.结果 肺炎组外周血白细胞计数为(9.3±5.1)×109个/L,显著高于对照组的(7.5±2.9)×109个/L;红细胞计数、血红蛋白、血小板计数分别为(4.3±0.6)×1012个/L、(131.1±18.7)g/L、(199.3 ±69.4)×109个/L,均显著低于对照组的(4.8±0.5)×1012个/L、(144.9±17.4) g/L、(237.9±72.5)×109个/L;D-二聚体、纤维蛋白(原)降解产物(FDPs)、纤维蛋白原(FIB)、活化的部分凝血活酶时间(APTT)、凝血酶原时间(PT)分别为(1.86±1.28) mg/L、(6.42±3.27) mg/L、(3.87±1.17) g/L、(35.64±8.34)s、(12.21±1.40)s,均显著高于对照组的(0.48±0.38) mg/L、(2.17±1.46) mg/L、(3.42±0.96) g/L、(31.29±11.19)s、(11.36±2.19)s;凝血酶时间(TT)为(13.43 ±3.38)s,显著低于对照组的(16.16±2.89)s(均P＜0.05).中高风险组D-二聚体、FDPs、降钙素原、CRP、APTT、PT分别为(2.94±1.14) mg/L、(8.85±2.82) mg/L、(1.72±1.16) μg/L、(104.2±61.9) mg/L、(38.80±8.41)s、(12.64±1.76)s,均显著高于低风险组的(1.16±0.78) mg/L、(4.85 ±2.49) mg/L、(0.40±0.51)μg/L、(67.4±59.5)mg/L、(33.60 ±7.69)s、(11.94±1.03)s;血小板计数、TT值分别为(172.8 ±57.1)×109个/L、(12.10±2.66)s,均显著低于低风险组的(216.5±71.6)×109个/L、(14.28 ±3.53)s(均P＜0.05).中高风险组降钙素原、D-二聚体、FDPs异常率分别为100.0％ (42/42)、95.2％ (40/42)、92.5％(37/42),均显著高于低风险组的86.2％(56/65)、75.4％(49/65)、44.6％(29/65)(均P＜0.05).D-二聚体、FDPs、降钙素原、CRP与PSI均呈正相关(r =0.636、0.608、0.629、0.250,均P＜0.05),血小板与PSI呈负相关(r=-0.320,P＜0.01).结论 CAP患者红细胞、血红蛋白、血小板低于正常人群,存在凝血及纤溶功能紊乱;D-二聚体、FDPs、降钙素原、CRP及血小板等与患者严重程度相关.
目的 比較不同嚴重程度社區穫得性肺炎(CAP)患者凝血及纖溶相關指標.方法 連續選取2013年7月至2014年6月于承德醫學院附屬醫院呼吸科住院的107例CAP患者作為肺炎組,同期52名門診健康體檢者作為對照組,檢測入選者血常規、凝血纖溶、降鈣素原及C-反應蛋白(CRP)等指標.將107例患者根據肺炎嚴重度指數(PSI)分為低風險組、中高風險組,觀察不同分組間上述指標的差異.結果 肺炎組外週血白細胞計數為(9.3±5.1)×109箇/L,顯著高于對照組的(7.5±2.9)×109箇/L;紅細胞計數、血紅蛋白、血小闆計數分彆為(4.3±0.6)×1012箇/L、(131.1±18.7)g/L、(199.3 ±69.4)×109箇/L,均顯著低于對照組的(4.8±0.5)×1012箇/L、(144.9±17.4) g/L、(237.9±72.5)×109箇/L;D-二聚體、纖維蛋白(原)降解產物(FDPs)、纖維蛋白原(FIB)、活化的部分凝血活酶時間(APTT)、凝血酶原時間(PT)分彆為(1.86±1.28) mg/L、(6.42±3.27) mg/L、(3.87±1.17) g/L、(35.64±8.34)s、(12.21±1.40)s,均顯著高于對照組的(0.48±0.38) mg/L、(2.17±1.46) mg/L、(3.42±0.96) g/L、(31.29±11.19)s、(11.36±2.19)s;凝血酶時間(TT)為(13.43 ±3.38)s,顯著低于對照組的(16.16±2.89)s(均P＜0.05).中高風險組D-二聚體、FDPs、降鈣素原、CRP、APTT、PT分彆為(2.94±1.14) mg/L、(8.85±2.82) mg/L、(1.72±1.16) μg/L、(104.2±61.9) mg/L、(38.80±8.41)s、(12.64±1.76)s,均顯著高于低風險組的(1.16±0.78) mg/L、(4.85 ±2.49) mg/L、(0.40±0.51)μg/L、(67.4±59.5)mg/L、(33.60 ±7.69)s、(11.94±1.03)s;血小闆計數、TT值分彆為(172.8 ±57.1)×109箇/L、(12.10±2.66)s,均顯著低于低風險組的(216.5±71.6)×109箇/L、(14.28 ±3.53)s(均P＜0.05).中高風險組降鈣素原、D-二聚體、FDPs異常率分彆為100.0％ (42/42)、95.2％ (40/42)、92.5％(37/42),均顯著高于低風險組的86.2％(56/65)、75.4％(49/65)、44.6％(29/65)(均P＜0.05).D-二聚體、FDPs、降鈣素原、CRP與PSI均呈正相關(r =0.636、0.608、0.629、0.250,均P＜0.05),血小闆與PSI呈負相關(r=-0.320,P＜0.01).結論 CAP患者紅細胞、血紅蛋白、血小闆低于正常人群,存在凝血及纖溶功能紊亂;D-二聚體、FDPs、降鈣素原、CRP及血小闆等與患者嚴重程度相關.
목적 비교불동엄중정도사구획득성폐염(CAP)환자응혈급섬용상관지표.방법 련속선취2013년7월지2014년6월우승덕의학원부속의원호흡과주원적107례CAP환자작위폐염조,동기52명문진건강체검자작위대조조,검측입선자혈상규、응혈섬용、강개소원급C-반응단백(CRP)등지표.장107례환자근거폐염엄중도지수(PSI)분위저풍험조、중고풍험조,관찰불동분조간상술지표적차이.결과 폐염조외주혈백세포계수위(9.3±5.1)×109개/L,현저고우대조조적(7.5±2.9)×109개/L;홍세포계수、혈홍단백、혈소판계수분별위(4.3±0.6)×1012개/L、(131.1±18.7)g/L、(199.3 ±69.4)×109개/L,균현저저우대조조적(4.8±0.5)×1012개/L、(144.9±17.4) g/L、(237.9±72.5)×109개/L;D-이취체、섬유단백(원)강해산물(FDPs)、섬유단백원(FIB)、활화적부분응혈활매시간(APTT)、응혈매원시간(PT)분별위(1.86±1.28) mg/L、(6.42±3.27) mg/L、(3.87±1.17) g/L、(35.64±8.34)s、(12.21±1.40)s,균현저고우대조조적(0.48±0.38) mg/L、(2.17±1.46) mg/L、(3.42±0.96) g/L、(31.29±11.19)s、(11.36±2.19)s;응혈매시간(TT)위(13.43 ±3.38)s,현저저우대조조적(16.16±2.89)s(균P＜0.05).중고풍험조D-이취체、FDPs、강개소원、CRP、APTT、PT분별위(2.94±1.14) mg/L、(8.85±2.82) mg/L、(1.72±1.16) μg/L、(104.2±61.9) mg/L、(38.80±8.41)s、(12.64±1.76)s,균현저고우저풍험조적(1.16±0.78) mg/L、(4.85 ±2.49) mg/L、(0.40±0.51)μg/L、(67.4±59.5)mg/L、(33.60 ±7.69)s、(11.94±1.03)s;혈소판계수、TT치분별위(172.8 ±57.1)×109개/L、(12.10±2.66)s,균현저저우저풍험조적(216.5±71.6)×109개/L、(14.28 ±3.53)s(균P＜0.05).중고풍험조강개소원、D-이취체、FDPs이상솔분별위100.0％ (42/42)、95.2％ (40/42)、92.5％(37/42),균현저고우저풍험조적86.2％(56/65)、75.4％(49/65)、44.6％(29/65)(균P＜0.05).D-이취체、FDPs、강개소원、CRP여PSI균정정상관(r =0.636、0.608、0.629、0.250,균P＜0.05),혈소판여PSI정부상관(r=-0.320,P＜0.01).결론 CAP환자홍세포、혈홍단백、혈소판저우정상인군,존재응혈급섬용공능문란;D-이취체、FDPs、강개소원、CRP급혈소판등여환자엄중정도상관.
Objective To compare the relevant indicators of coagulation and fibrinolysis in patients with varying severity of community-acquired pneumonia (CAP).Methods A total of 107 CAP hospitalized patients at Department of Respiratory Medicine,Affiliated Hospital,Chengde Medical College from July 2013 to June 2014 were enrolled as pneumonia group while another 52 healthy outpatients served as control group.The levels of routine blood test,coagulation function,procalcitonin and C-reactive protein (CRP) were measured and compared among different groups.All hospitalized CAP patients were divided into low and high-risk groups according to pneumonia severity index (PSI).And all indicators were measured to examine the differences among different groups.Results The white blood cell count in pneumonia group was significantly higher than that in control group ((9.3 ± 5.1) vs (7.5 ± 2.9) × 109/L,P ＜ 0.05).The red blood cell count,hemoglobin and platelet count in pneumonia group were significantly lower than those in control group ((4.3±0.6) vs (4.8 ±0.5) × 1012/L,(131.1 ±18.7) vs (144.9 ± 17.4) g/L,(199.3 ±69.4) vs (237.9 ±72.5) × 109/L,all P ＜0.05).The D-dimer,fibrinogen degradation products (FDPs),fibrinogen (FIB),activated partial thromboplastin time (APTT) and prothrombin time (PT) in pneumonia group were significantly higher than those in control group ((1.86 ± 1.28) vs (0.48 ± 0.38) mg/L,(6.42±3.27) vs (2.17±1.46) mg/L,(3.87±1.17) vs (3.42±0.96) g/L,(35.64±8.34) vs (31.29 ± 11.19) s,(12.21 ± 1.40) vs (11.36 ± 2.19) s,all P ＜ 0.05) while thromboplastin time (TT) was lower than that in control group ((13.43 ± 3.38) vs (16.16 ± 2.89) s,P ＜ 0.05).The levels of D-dinner,FDPs,procalcitonin,CRP,APTT and PT in high-risk group were significantly higher than those in low-risk group ((2.94 ± 1.14) vs (1.16 ± 0.78) mg/L,(8.85 ± 2.82) vs (4.85 ± 2.49) mg/L,(1.72±1.16) vs (0.40±0.51) μg/L,(104.2 ±61.9) vs (67.4 ±59.5) mg/L,(38.80 ±8.41) vs (33.60 ± 7.69) s,(12.64 ± 1.76) vs (11.94 ± 1.03) s,all P ＜ 0.05) while platelet count and TT were lower than those in low-risk group ((172.8 ± 57.1) vs (216.5 ± 71.6) × 109/L,(12.10 ± 2.66) vs (14.28 ± 3.53) s,all P ＜ 0.05).The abnormal rates of procalcitonin,D-dimer and FDPs in high-risk group were significantly higher than those in low-risk group (100％ (42/42) vs 86.2％ (56/65),95.2％ (40/42) vs 75.4％ (49/65),95.2％ (37/42) vs 44.6％ (29/65),all P ＜ 0.05).The plasma levels of D-dimer,FDPs,procalcitonin and CRP were well-correlated with index of pneumonia severity (r =0.636,0.608,0.629,0.250,all P ＜ 0.05).And the plasma level of platelet was negatively correlated with index of pneumonia severity (r =-0.320,P ＜ 0.01).Conclusions The red blood cell,hemoglobin and platelets arc lower in patients with pneumonia than those in normal subjects.And the patients with pneumonia have coagulation and fibrinolysis disorders.The plasma levels of D-dimer,FDPs,procalcitonin,CRP and platelets are well-correlated with severity of CAP.
