摘要
目的探讨成年重症患者凝血酶-抗凝血酶复合物(thrombin-antithrombin complex,TAT)/纤溶酶-α2纤溶酶抑制物复合物(α2-plasmin inhibitor-plasmin complex,PIC)(TAT/PIC)水平与机械通气(mechanical ventilation,MV)使用率间的关系。方法采用横断面研究,纳入单次入重症医学科且入科时长≥1 d且有血栓前四项检测记录的成年患者。在医院信息系统及实验室信息系统中回顾性收集患者年龄、性别、首次血栓前四项检测结果、弥散性血管内凝血(disseminated intravascular coagulation,DIC)评分、治疗方式及所有诊断信息。采用Logistic回归模型探讨TAT/PIC与MV使用率间的关系;采用交互作用分析、亚组分析探讨在不同年龄、性别、感染/未感染、患/未患DIC患者中TAT/PIC水平与MV使用间的关系是否存在统计学差异。结果本研究共纳入1176名患者,所有患者首次TAT/PIC的中位数为15.84(8.13-33.11)。多因素Logistic回归分析结果显示,TAT/PIC每增加5个数值,使用MV的可能性提高2.9%(OR=1.029,95%CI:1.008~1.050),Q3患者使用MV可能性是Q1患者的1.566倍(OR=1.566,95%CI:1.095~2.239),Q4患者使用MV可能性是Q1患者的2.457倍(OR=2.457,95%CI:1.694~3.563)。交互作用结果显示,TAT/PIC与MV使用率间的关系在感染和未感染患者中存在统计学差异(P_(interaction)=0.02)。亚组分析显示,在感染患者中(674例),TAT/PIC每增加5个数值,MV使用可能性提高5.9%(OR=1.059,95%CI:1.022~1.097,P=0.001),而在未感染患者中(502例),TAT/PIC与MV使用率间差异无统计学意义(OR=1.012,95%CI:0.984~1.040,P=0.405)。结论在感染的重症患者中,TAT/PIC水平与患者是否使用MV存在相关性。
Objective To investigate the relationship between the level of thrombin-antithrombin complex(TAT)/α2-plasmin inhibitor-plasmin complex(PIC) and the utilization rate of mechanical ventilation(MV) in critically ill patients. Methods For the cross-sectional study, adult patients who had been admitted to the intensive c are unit(ICU) for one day or longer and had a record of the first four tests for thrombosis were enrolled. Age, gender, the results of TAT and PIC, disseminated intravascular coagulation score, treatment, and diagnostic information were retrospectively collected from the hospital information system and laboratory information system. Logistic regression model was used to explore the relationship between TAT/PIC and the MV utilization rate. Interaction analysis and subgroup analysis were conducted to explore whether there was any difference between patients with different age and gender, patients with/without DIC, and with/without infection. Results A total o f 1 176 patients were enrolled in this study. The median of the first TAT/PIC was 15.84(8.13-33.11) in all the patients. The multivariable Logistic regression model results showed that for every 5 increase in TAT/PIC, the possibility of using MV increased by 2.9%(OR=1.029, 95% CI: 1.008-1.050), and the possibility of using MV in Q3 patients was 1.566 times than that in Q1 patients(OR=1.566, 95% CI: 1.095-2.239);the possibility of using MV in Q4 patients was 2.457 times than that in Q1 patients(OR=2.457, 95% CI: 1.694-3.563). Interaction results showed that the relationship between the level of TAT/PIC and MV usage was different in patients with and without infection(P_(interaction)=0.02). Further subgroup analysis showed that in the infected patients(674 cases), the possibility of using MV increased by 5.9% for every 5 increase in TAT/PIC(OR=1.059, 95% CI: 1.022-1.097, P=0.001), while there was no significant difference between different TAT/PIC and MV usage in non-infected patients(502 cases)(OR =1.012, 95% CI: 0.984-1.040, P=0.405). Conclusion There is a correlation b etween the level of TAT/PIC and mechanical ventilation in patients with infection in the ICU.
作者
李佳媚
刘三媛
李若寒
张小玲
骆艳妮
张磊
王小闯
王岗
LI Jiamei;LIU Sanyuan;LI Ruohan;ZHANG Xiaoling;LUO Yanni;ZHANG Lei;WANG Xiaochuang;WANG Gang(Department of Critical Care Medicine,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China;Department of Laboratory Medicine,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China)
出处
《西安交通大学学报（医学版）》
CAS
CSCD
北大核心
2022年第6期872-878,共7页
Journal of Xi’an Jiaotong University（Medical Sciences）
基金
国家自然科学基金资助项目(No.81770057)
西安交通大学第二附属医院院级科研项目[No.YJ(QN)202023]
陕西省“高层次人才特殊支持计划”。
作者简介
通信作者:王岗,教授,研究员,副主任医师,博士生导师.E-mail:gang_wang@xjtu.edu.cn。
