文章摘要
抗凝血酶Ⅲ预测脓毒症患者死亡的价值
Predictive value of antithrombin Ⅲ on the death in patients with sepsis
  
DOI：10.12089/jca.2020.02.014
中文关键词: 脓毒症  抗凝血酶Ⅲ  预后
英文关键词: Sepsis  Antithrombin Ⅲ  Prognosis
基金项目:安徽省自然科学基金(1608085MH199),安徽省高校拔尖人才项目 (gxbjZD19),皖医弋矶山医院 “高峰”培育计划(GF2019J03)
作者单位E-mail
夏炎 241001,安徽省芜湖市,皖南医学院弋矶山医院麻醉与重症医学科  
郭志远 241001,安徽省芜湖市,皖南医学院弋矶山医院麻醉与重症医学科  
张慧娟 241001,安徽省芜湖市,皖南医学院弋矶山医院麻醉与重症医学科  
祁羽鹏 241001,安徽省芜湖市,皖南医学院弋矶山医院麻醉与重症医学科  
曹迎亚 241001,安徽省芜湖市,皖南医学院弋矶山医院麻醉与重症医学科  
鲁卫华 241001,安徽省芜湖市,皖南医学院弋矶山医院麻醉与重症医学科 lwh683@126.com 
金孝岠 241001,安徽省芜湖市,皖南医学院弋矶山医院麻醉与重症医学科  
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中文摘要:
      
目的 分析脓毒症患者凝血功能与预后的关系,探讨抗凝血酶Ⅲ(antithrombin Ⅲ, AT-Ⅲ)活性预测脓毒症预后的临床价值。
方法 回顾性分析2018年6月1日至12月31日在我院重症医学科治疗的脓毒症患者62例,男37例,女25例,年龄22～88岁,根据确诊脓毒症后30 d内的死亡情况将患者分为两组:死亡组（n=21）和生存组（n=41）。收集患者性别、年龄、实验室检查等资料,比较两组确诊脓毒症当天的外周静脉血AT-Ⅲ、凝血指标［D-2聚体(D-D)、纤维蛋白降解产物(FDP)、纤维蛋白原(FIB)、凝血酶时间(TT)、活化部分凝血酶原时间(APTT)、国际标准化比值(INR)、凝血酶原时间(PT)］、C反应蛋白（CRP)、Plt等。
结果 死亡组AT-Ⅲ活性明显低于生存组［(57.3±16.9)％ vs(76.1±21.1)％,P＜0.001］。AT-Ⅲ是脓毒血症患者死亡预后的独立预测因素(OR=0.949,95％CI 0.917～0.982,P=0.03)。AT-Ⅲ预测脓毒症患者死亡预后的ROC曲线下面积为0.748(95％CI 0.621～0.875,P＜0.001),以AT-Ⅲ值62.0％为临界值,其预测的敏感度为78.0％,特异度为61.9％。
结论 脓毒症早期抗凝血酶Ⅲ活性的降低可能预示着预后不良,抗凝血酶Ⅲ作为早期评估脓毒症严重程度的指标对临床具有重要的指导意义。
英文摘要:
      
Ojective To analyze the relationship between coagulation function and prognosis in patients with sepsis and explore the value of antithrombin Ⅲ (AT-Ⅲ) in the prognosis of sepsis.
Methods A retrospective analysis of 62 patients (37 males and 25 females, aged 22-88 years) with sepsis treated in our intensive care department from June 2018 to February 2018 was conducted. The patients were divided into two groups according to the 30-day mortality: the death group (n = 21) and the survival group (n = 41). The general information such as gender, age and laboratory tests were recorded. The AT-Ⅲ, the coagulation index ［D-Dimer (D-D), fibrin degradation product (FDP), fibrinogen (FIB), thrombin time (TT), activated partial thromboplastin time (APTT), international normalized ratio (INR), prothrombin time (PT)］, the inflammation index [C-created protein (CRP)] and platelet count (Plt) were tested and compared between the two groups.
Results Compared with the survival group, the level of AT-Ⅲ in the death group was significantly lower ［(57.3 ± 16.9)％ vs (76.1 ± 21.1)％, P ＜ 0.001］. AT-Ⅲ was an independent risk for predicting poor prognosis in patients with sepsis (OR = 0.949, 95％ CI 0.917-0.982, P = 0.03). The area under the curve (AUC) of AT-Ⅲ in predicting the prognosis of death in patients with sepsis was 0.748 (95％ CI 0.621-0.875, P ＜ 0.001). The AT-Ⅲ threshold of 62.0％ had a sensitivity of 78.0％ and a specificity of 61.9％.
Conclusion In the early stage of sepsis, the decrease of AT-Ⅲ may indicate a poor prognosis. AT-Ⅲ has important clinical implications as an early indicator for assessing the severity of sepsis.
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