探讨血浆sCD40L与脓毒症严重程度及预后的相关性

doi:10.3969/j.issn.1002-1949.2017.10.005

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摘要目的：探讨血浆sCD40L浓度与脓毒症患者严重程度及其预后的相关性。方法：采用前瞻性研究方法，将天津市第一中心医院 ICU 病房收治的 84 例脓毒症患者按有无血小板减少分为无血小板减少组(＞100×109/L)及血小板减少组（＜100×109/L），其中血小板减少组又细分为轻度减少组［(50～100)×109/L］、中度减少组［(20～50)×109/L］、重度减少组(＜20×109/L)。入院后24h内对患者进行采血并记录各项临床生理及实验室检测指标。分析各组血浆sCD40L浓度与APACHE、SOFA评分及血小板计数的相关性；以28d为终点分析血浆sCD40L对脓毒症患者不良预后的评估能力。结果： ①无血小板减少组血浆 sCD40L 浓度(pg/mL)显著高于血小板减少组及健康组（P＜0.001），且随着血小板减少程度逐渐加重 sCD40L 浓度逐渐减少(P＜0.001)；②无血小板减少组 sCD40L 与 PLT计数无明显相关性(P＞0.05)，与 APACHEⅡ及 SOFA 评分呈正相关(r1=0.869，P＜0.001，r2=0.437，P=0.018)。血小板减少组sCD40L 与 PLT 计数呈正相关(r=0.936，P＜0.001)，而与 APACHEⅡ、SOFA 评分无明显相关性(P＞0.05)；③血浆sCD40L浓度预测脓毒症无血小板减少患者的28d病死率的受试者工作特征曲线(ROC 曲线)下面积为0.799，95%CI 为 0.625～0.973，P=0.019，预测28d病死率的最佳界值为 229.411 pg/mL。结论：血浆sCD40L浓度能够提示脓毒症不伴血小板减少患者的病情严重程度；血浆sCD40L浓度可用于脓毒症无血小板减少患者28d的预后判断。

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	王淼
	曹书华
	王兵
	虞美霞
	杨俊
	王勇强

收稿日期: 2017-04-10

通讯作者: 王勇强（1962-），男，主任医师，E-mail:yongqiangwang1962@sina.com

作者简介: 王淼（1988-），女，博士，E-mail:351311291@qq.com

引用本文:

王淼，曹书华，王兵，虞美霞，杨俊，王勇强. 探讨血浆sCD40L与脓毒症严重程度及预后的相关性[J]. 中国急救医学, 2017, 37(10): 894-899.
Wang Miao, Cao Shu-hua, Wang Bing, Yu Mei-xia, Yang Jun, Wang Yong-qiang. Relationship of plasma CD40L levels to the severity of sepsis and prognosis. Chinese Journal of Critical Care Medicine, 2017, 37(10): 894-899.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2017.10.005 或 http://www.cnemergency.org.cn/CN/Y2017/V37/I10/894

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