D-二聚体联合乳酸对急诊科疑似脓毒症患者预后的预测价值

doi:10.3969/j.issn.1002-1949.2018.04.010

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摘要目的观察不同严重程度脓毒症患者D-二聚体（D-Dimer, D-D）、乳酸(Lactic Acid, Lac)和C反应蛋白(C-reactive protein, CRP)水平变化，探讨D-D、Lac对脓毒症患者预后评估的临床价值。方法回顾性分析急诊科209例临床诊断疑似脓毒症患者的临床资料。根据sepsis-3诊断标准分为感染性休克组（76例）、脓毒症组（75例）和单纯感染组（58例），分别比较三组患者CRP、D-D、Lac的表达和临床转归，应用Logistic回归分析，筛选出影响脓毒症患者预后的独立危险因素，应用ROC曲线评价D-D和Lac对脓毒症患者预后的评估价值。结果 ①单纯感染组、脓毒症组、感染性休克组的患者住院病死率分别为0.00%、37.30%、81.60%，差异有统计学意义(P＜0.05)；与单纯感染组比较，感染性休克组D-D、CRP和Lac明显升高（P＜0.05），脓毒症组Lac明显升高（P＜0.05）；感染性休克组D-D和Lac水平高于脓毒症组（P＜0.05）。②Logistic回归分析显示，D-D和Lac是脓毒症患者死亡的独立危险因素。③以D-D和Lac拟合生成联合预测因子曲线下面积（AUC=0.892）大于D-D单独检测（AUC=0.798， Z=3.287，P＜0.05）；单独检测D-D与Lac判断脓毒症患者预后的AUC比较，差异无统计学意义(Z=1.609，P＞0.05)。结论 CRP、D-D和Lac的变化程度与脓毒症患者的病情严重程度密切相关，D-D和Lac是脓毒症患者预后的独立危险因素。联合检测D-D和Lac对脓毒症患者预后评估具有更高的临床价值。

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	李心笛
	寿松涛

关键词 ：脓毒症, C反应蛋白(CRP), D-二聚体(D-D), 乳酸(Lac)

通讯作者: 寿松涛（1966-），女，博士，主任医师，教授，急诊医学科副主任，E-mail：stshou66@sina.com。

作者简介: 李心笛（1991-），女，硕士，E-mail：cd660411@163.com。

引用本文:

李心笛，寿松涛. D-二聚体联合乳酸对急诊科疑似脓毒症患者预后的预测价值[J]. 中国急救医学, 2018, 38(4): 323-.
Li Xin-di, Shou Song-tao. The predictive value of d-dimer combined with lactic acid in the prognosis of patients with suspected sepsis in emergency department. Chinese Journal of Critical Care Medicine, 2018, 38(4): 323-.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.04.010 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I4/323

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