摘要
目的 探讨中性粒细胞侧向荧光(NE-SFI)强度对重症中暑(HS)合并弥散性血管内凝血(DIC)的早期诊断价值。方法 选取南部战区总医院2017年1月1日-2018年12月31日收治的HS患者34例,依据国际血栓与止血学会(ISTH)发布的显性DIC评分标准,将34例患者分为HS未合并DIC组(DIC评分<5分,n=23)与HS合并DIC组(DIC评分≥5分,n=11)。比较两组患者的一般资料,NE-SFI,以及血清中性粒细胞胞外诱捕网(NETs)相关标志物dsDNA、髓过氧化物酶(MPO)、瓜氨酸化组蛋白(CitH3)的水平。利用受试者工作特征(ROC)曲线分析NE-SFI对HS合并DIC的早期诊断价值。结果 两组患者年龄、发病最高核心体温、白细胞计数、中性粒细胞计数比较差异均无统计学意义(P>0.05)。HS合并DIC组3 h内核心温度降至38.5℃以下患者比例、GCS评分低于HS未合并DIC组,谷丙转氨酶(ALT)、肌酐、ISTH评分、并发多器官功能障碍综合征(MODS)比例高于HS未合并DIC组,差异均有统计学意义(P<0.05)。发病第1~3天,HS合并DIC组的NE-SFI值均高于HS未合并DIC组,差异有统计学意义(P<0.001)。HS合并DIC组患者的血清dsDNA、MPO、CitH3水平[分别为(372.93±135.77) ng/ml、(108.32±38.58) pg/ml、(600.18±183.74) ng/μl]明显高于HS未合并DIC组[分别为(30.14±7.01) ng/ml、(56.39±34.64) pg/ml、(320.26±89.60) ng/μl],差异有统计学意义(P<0.001)。Spearman相关分析显示:发病第1~3天的NE-SFI值与发病第1天的dsDNA、MPO、CitH3水平均呈正相关(P<0.05或P<0.01)。ROC曲线分析显示,发病第2天的NE-SFI值对HS合并DIC的诊断效能最高,其AUC为0.921(95%CI0.820~1.000,P<0.001)。结论 NE-SFI可作为早期诊断HS并发DIC的有效指标。
Objective To investigate the early diagnosis value of neutrophil-side-fluorescence intensity(NE-SFI)on heat stroke(HS)-related disseminated intravascular coagulation(DIC).Methods According to the International Society of Thrombosis and Haemostasis(ISTH)scoring criteria,thirty-four HS patients admitted to the General Hospital of Southern Theater Command from January 1,2017 to December 31,2018 were selected and divided into HS without DIC group(DIC score<5 points,n=23)and HS with DIC group(DIC score≥5 points,n=11).The patient's general information,NE-SFI,and neutrophil extracellular traps(NETs)-related markers such as,dsDNA(double-stranded DNA),myeloperoxidase(MPO)and citrullinated histone(CitH3)were compared between the two groups.Receiver operating characteristic(ROC)curve was used to analyze the early diagnostic value of NE-SFI in HS with DIC.Results There was no significant difference in age,maximum body temperature,white blood cell count and neutrophil count between the two groups(P>0.05).The proportion of patients in the HS with DIC group whose core temperature dropped below 38.5℃within 3 hours and the GCS(Glasgow Coma Scale)score were lower than those in the HS without DIC group,while the alanine aminotransferase(ALT),creatinine,ISTH(International Society of Thrombosis and Haemostasis)score,and the proportion of concurrent multiple organ dysfunction syndrome(MODS)in the HS with DIC group were higher than those in the HS without DIC group(P<0.05).On the 1st to 3rd day of onset,the NE-SFI values of the HS with DIC group were higher than those of the HS without DIC group(P<0.001).Compared with the serum dsDNA,MPO,and CitH3 in HS without DIC group[respectively(30.14±7.01)ng/ml,(56.39±34.64)pg/ml,(320.26±89.60)ng/μl],the serum dsDNA,MPO and CitH3 levels in HS with DIC group[respectively(372.93±135.77)ng/ml,(108.32±38.58)pg/ml,(600.18±183.74)ng/μl]are significantly increased(P<0.001).Spearman correlation analysis showed that the value of NE-SFI on day 1-3 were positively correlated with the levels of dsDNA,MPO and CitH3 on day 1(P<0.05 or P<0.01).ROC curve analysis showed that NE-SFI on day 2 had a high value for the early diagnosis of HS complicated with DIC,and its AUC was 0.921(95%CI 0.820-1.000,P<0.001).Conclusion NE-SFI can be used as an effective indicator for the early diagnosis in HS complicated with DIC.
作者
陈文达
彭娜
刘帅
童华生
唐柚青
刘靖华
苏磊
Chen Wen-Da;Peng Na;Liu Shuai;Tong Hua-Sheng;Tang You-Qing;Liu Jing-Hua;Su Lei(Department of Emergency,General Hospital of Southern Theater Command,Guangzhou,Guangdong 510010,China;Graduate School,Guangdong Pharmaceutical University,Guangzhou,Guangdong 510080,China;Department of Pathophysiology,Southern Medical University/Guangdong Provincial Key Laboratory of Proteomics,Guangzhou,Guangdong 510515,China;Department of Intensive Care Unit/Key Laboratory of Hot Zone Trauma Care and Tissue Repair of Chinese PLA,General Hospital of Southern Theater Command,Guangzhou,Guangdong 510010,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2023年第4期431-436,共6页
Medical Journal of Chinese People's Liberation Army
基金
国家自然科学基金青年基金(81701892)
中国博士后科学基金面上项目(2017M622737)。
关键词
重症中暑
弥散性血管内凝血
中性粒细胞侧向荧光
多器官功能障碍综合征
heat stroke
disseminated intravascular coagulation
neutrophil-side-fluorescence intensity
multiple organ dysfunction syndrome
