摘要
目的探讨血浆组织型纤溶酶原激活物-抑制剂复合物(t-PAIC)对热射病性凝血病(heat stroke-induced coagulopathy,HIC)的诊断价值。方法回顾性分析2018年5月至2023年9月解放军联勤保障部队第九〇八医院重症医学科收治的65例热射病患者,根据热射病严重程度分为热衰竭(heat exhaustion,HE)组(n=32)、热射病无凝血病(nHIC)组(n=13)和HIC组(n=20),比较三组患者t-PAIC水平变化,并进行相关性分析,绘制受试者工作特征(ROC)曲线,评估t-PAIC诊断HIC的价值。结果与HE组比较,nHIC组和HIC组t-PAIC显著升高[ng/mL:2.69(1.46~5.07)vs.8.70(3.99~20.41)和21.99(12.36~43.27),P<0.05];与nHIC组比较,HIC组t-PAIC显著升高(P<0.05)。Spearman相关分析显示,热射病患者乳酸水平、APACHEⅡ评分与t-PAIC水平均呈正相关(相关系数r分别为0.500、0.645,P<0.001)。t-PAIC诊断HIC的曲线下面积为0.843(P<0.05);当t-PAIC截断值为11.43 ng/mL时,其敏感度为80.0%,特异度为82.2%。结论血浆t-PAIC水平与热射病严重程度相关,可作为诊断HIC的分子标志物。
Objective To investigate the clinical value of tissue-type fibrinolytic activator-inhibitor complex(t-PAIC)in the diagnosis of heat stroke-induced coagulopathy(HIC).Methods We retrospectively analyzed 65 patients with heat stroke admitted to the Department of Critical Care Medicine of No.908th Hospital of Joint Logistic Support Force of Chinese PLA from May 2018 to September 2023.According to the severity of heat stroke,they were divided into heat exhaustion(HE)group(n=32),non-heat stroke coagulopathy(nHIC)group(n=13),and HIC group(n=20).The changes of t-PAIC levels among the three groups were compared,Spearman correlation analysis was used to evaluate the correlation of t-PAIC with the lactic acid level and acute physiology and chronic health evaluationⅡ(APACHEⅡ),and receiver operating characteristic(ROC)curves were drawn to evaluate the diagnostic value of t-PAIC for HIC.Results Compared with the t-PAIC level in the HE group,the t-PAIC level in the nHIC group and the HIC group were significantly increased[ng/mL:2.69(1.46-5.07)vs.8.70(3.99-20.41)and 21.99(12.36-43.27),P<0.05],and the t-PAIC level of the HIC group was significantly higher than that of the nHIC group(P<0.05).Spearman correlation analysis showed that the lactic acid level and APACHEⅡscore in heat stroke patients were positively correlated with t-PAIC level(correlation coefficient r was 0.500 and 0.645,P<0.001).The area under the ROC curve for t-PAIC in diagnosing HIC was 0.843(P<0.05);when the t-PAIC cut-off value was 11.43 ng/mL,the sensitivity was 80.0%and the specificity was 82.2%.Conclusions The plasma t-PAIC level is correlated with the severity of heat stroke,and can be used as a molecular marker for the diagnosis of HIC.
作者
何龙平
钟林翠
余永春
林青伟
周叶
彭恩兰
宋景春
He Longping;Zhong Lincui;Yu Yongchun;Lin Qingwei;Zhou Ye;Peng Enlan;Song Jingchun(Critical Care Department,No.908th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army,Key Laboratory of Thrombosis and Hemostasis of Nanchang City,Nanchang 330002,China)
出处
《中国急救医学》
CAS
CSCD
2024年第6期526-530,共5页
Chinese Journal of Critical Care Medicine
基金
2022年全军基础加强计划项目(2022-JCJQ-ZD-097-11)
中国医药教育协会2022重大科学攻关课题(2022KTZ013)
江西省卫健委科技计划(202311381)。
关键词
组织型纤溶酶原激活物-抑制剂复合物
热衰竭
热射病
热射病性凝血病
Tissue-type fibrinolytic activator-inhibitor complex
Heat exhaustion
Heat stroke
Heat stroke-induced coagulopathy
作者简介
何龙平(1993-),男,硕士,E-mail:helongping2856@163.com;通信作者:宋景春(1978-),男,博士,博士生导师,主任医师,E-mail:songjingchun@126.com。
