摘要
目的观察普通型与重型新型冠状病毒肺炎(corona virus disease 2019,COVID-19)患者初诊时凝血功能指标的差异,动态观察重型患者治疗过程中凝血功能指标的变化与病情的相关性,分析抗凝治疗时机与预后的相关性,探讨COVID-19患者凝血功能指标的变化及其临床意义。方法回顾性分析72例COVID-19患者(普通型40例、重型32例)初诊时凝血功能指标的变化,并选取40例普通肺炎患者作为对照组。将32例重型患者根据病情的转归情况分为好转组(n=16)与转危组(n=16),动态观察患者凝血功能指标的变化与病情的相关性。将32例重型患者根据抗凝治疗启动的时机,分为未抗凝组(n=11)、预防性抗凝组(n=6)和延迟抗凝组(n=15),对比分析抗凝治疗时机与预后的相关性。结果普通型COVID-19患者未见明显累及凝血系统,但重型或危重型COVID-19患者存在明显的凝血功能紊乱;病情加重时D-二聚体(D-Dimer,D-D)、纤维蛋白降解产物、Ⅷ因子活性等凝血功能指标明显上升,尤其是D-D会显著升高;对重型COVID-19患者进行预防性抗凝治疗有利于改善预后。结论D-D的显著升高可以作为COVID-19患者病情进展的预警信号,积极地进行预防性抗凝治疗有利于改善重型COVID-19患者的预后。
Objective To observe the differences of coagulation-related indicators between the common and the severe corona virus disease 2019(COVID-19)patients at the initial diagnosis,to observed the relationship between the changes of coagulation-related indicators in the severe patients and the illness during the treatment,to analyze the correlation between the timing of anticoagulation treatment and prognosis,and to investigate the changes of coagulation-related indicators in patients with COVID-19 and the clinical significance.Methods The changes of coagulation-related of 72 COVID-19 patients(40 common cases,32 severe cases)at the initial diagnosis were retrospectively analyzed,40 patients with common pneumonia were selected as the control group.The severe patients were divided into improvement group(n=16)and risk group(n=16)according to the outcome of the disease,and the relationship between the changes of coagulation-related indicators and the illness was dynamically detected.The severe patients were divided into non anticoagulant group(n=11),preventive anticoagulant group(n=6)and delayed anticoagulant group(n=15),and the correlation between the timing of anticoagulant therapy and prognosis was analyzed.Results There was no obvious involvement of the coagulation system of the common COVID-19 patients,while the coagulation disorders were found in the severe or critical COVID-19 patients.The indexes of coagulation function,such as D-dimer(D-D),fibrin degradation products andⅧfactor activity were significantly increased with the exacerbation of the disease.Conclusion The significant increase of D-D can be considered as an early warning signal for the progression of COVID-19 patients.Active preventive anticoagulation therapy is beneficial to the prognosis of the severe COVID-19 patients.
作者
刘玉荣
吴妍雯
张方琪
毛从政
刘海潮
胡丹
胡振红
LIU Yurong;WU Yanwen;ZHANG Fangqi;MAO Congzheng;LIU Haichao;HU Dan;HU Zhenhong(Department of Respiratory Medicine,General Hospital of Central Theater Command,Wuhan Hubei 430070,China)
出处
《华南国防医学杂志》
CAS
2020年第12期869-872,876,共5页
Military Medical Journal of South China
基金
湖北省自然科学基金项目(2017CFC876)
作者简介
通信作者:吴妍雯,E-mail:19748614@qq.com
