摘要
目的评估凝血酶抗凝酶复合物(TAT)、血栓调节蛋白(TM)、纤溶酶-抗纤溶酶复合物(PIC)和组织型纤溶酶原激活抑制复合物(t-PAIC)与重型血液毒毒蛇咬伤中毒后弥散性血管内凝血(DIC)的临床相关性及预测价值。方法连续纳入2019年4月至2023年4月收治的重型血液毒毒蛇咬伤中毒患者作为研究对象,共132例。依据住院期间是否出现DIC分为观察组(发生DIC,n=37)及对照组(未发生DIC,n=95)。检测2组血浆TAT、TM、PIC、t-PAIC浓度。应用二元、无分类协变量的非条件Logistic回归分析TAT、TM、PIC、t-PAIC浓度与重型血液毒毒蛇咬伤中毒后DIC的临床相关性,建立受试者工作特征(ROC)曲线分析TAT、TM、PIC、t-PAIC对重型血液毒毒蛇咬伤中毒后DIC的预测能力。结果观察组TAT、TM、PIC、t-PAIC显著高于对照组(P<0.05)。二元、无分类协变量的非条件Logistic回归分析显示,TAT[OR=1.517(95%CI:1.155,1.879)]、TM[OR=1.647(95%CI:1.108,2.186)]、PIC[OR=3.989(95%CI:2.986,4.992)]、t-PAIC[OR=1.111(95%CI:0.854,1.368)]是重型血液毒毒蛇咬伤中毒患者发生DIC的危险因素(P<0.05)。ROC曲线分析显示,TAT、TM、PIC、t-PAIC是预测重型血液毒毒蛇咬伤中毒患者DIC的有效指标(P<0.05),其曲线下面积(AUC)分别为0.865(95%CI:0.790,0.939)、0.771(95%CI:0.673,0.870)、0.847(95%CI:0.804,0.889)、0.680(95%CI:0.573,0.787),联合预测效能更优异(P<0.001),AUC为0.904(95%CI:0.875,0.933)。结论TAT、TM、PIC和t-PAIC检测对判断重型血液毒毒蛇咬伤中毒患者是否发生DIC有重要参考价值,可以较好地评估患者凝血功能状态,4个指标联合预测DIC的效能更优。
Objective To evaluate the clinical correlation of thrombin anticoagulase complex(TAT),thrombomodulin(TM),plasmin antiplasmin complex(PIC)and tissue plasminogen activation inhibition complex(t-PAIC)with disseminated intravascular coagulation(DIC)after severe hematotoxic venomous snake bite poisoning and their predictive value.Methods A total of 132 patients with severe hematotoxic venomous snake bite poisoning admitted from April 2019 to April 2023 were included as the research subjects.According to presence of DIC during hospitalization,the patients were divided into observation group(occurrence of DIC,n=37)and control group(occurrence of DIC,n=95).Plasma concentrations of TAT,TM,PIC and t-PAIC in the two groups were detected.The clinical correlation between the concentrations of TAT,TM,PIC and t-PAIC and DIC after severe hematotoxic venomous snake bite poisoning was analyzed by binary,noncategorical,unconditioned Logistic regression analysis.Receiver operating characteristic(ROC)curve was established to analyze the predictive ability of TAT,TM,PIC and t-PAIC for DIC after severe hematotoxic venomous snake bite poisoning.Results TAT,TM,PIC and t-PAIC in observation group were significantly higher than those in control group(P<0.05).Binary,unconditioned Logistic regression analysis without classified covariates showed that TAT[OR=1.517(95%CI:1.155,1.879)],TM[OR=1.647(95%CI:1.108,2.186)],PIC[OR=3.989(95%CI:2.986,4.992)]and t-PAIC[OR=1.111(95%CI:0.854,1.368)]were risk factors for DIC in patients with severe hematotoxic venomous snake bite poisoning(P<0.05).ROC curve analysis showed that TAT,TM,PIC and t-PAIC were effective indicators for predicting DIC in patients with severe hematotoxic venomous snake bite poisoning(P<0.05),and the area under the curve(AUC)of the above indicators was 0.865(95%CI:0.790,0.939),0.771(95%CI:0.673,0.870),0.847(95%CI:0.804,0.889),and 0.680(95%CI:0.573,0.787),respectively,and the combined prediction efficiency was better(P<0.001),with the AUC of 0.904(95%CI:0.875,0.933).Conclusion TAT,TM,PIC and t-PAIC detection have important reference value in judging whether DIC occur in patients with severe hematotoxic venomous snake bite poisoning,and can better evaluate the status of patients'coagulation function,and the combined detection of the four indicators is more effective in predicting DIC.
作者
覃双全
曾宪华
刘笋
何熔
罗亚玲
朱首珍
骆立晖
印伟
QIN Shuangquan;ZENG Xianhua;LIU Sun;HE Rong;LUO Yaling;ZHU Shouzhen;LUO Lihui;YIN Wei(Department of Emergency,the First People's Hospital of Changde City,Changde,Hunan 415003,China)
出处
《临床误诊误治》
CAS
2024年第13期51-56,共6页
Clinical Misdiagnosis & Mistherapy
基金
常德市技术创新引导项目(常科函﹝2022﹞51号)。
