本文選題：社區(qū)獲得性肺炎 + 凝血異常��； 參考：《福建醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的通過探討社區(qū)獲得性肺炎(community-acquired pneumonia, CAP)患者相關(guān)凝血指標(biāo)變化,揭示凝血指標(biāo)異常在CAP病情判斷及預(yù)后評(píng)估方面的價(jià)值,以更好指導(dǎo)CAP臨床診斷及治療 方法回顧性分析廈門大學(xué)附屬第一醫(yī)院呼吸內(nèi)科2010年6月至2011年5月收治的CAP患者385例,同期住院除外感染、腫瘤、外傷、血栓性疾病等因素的患者146例作為對(duì)照組,入院后4小時(shí)內(nèi)立即取外周靜脈血檢測血細(xì)胞計(jì)數(shù),磁珠法檢測凝血四項(xiàng),免疫比濁法檢測D-二聚體,CAP患者同時(shí)進(jìn)行肺炎嚴(yán)重度指數(shù)(pneumonia severity index, PSI)分級(jí)。通過上述指標(biāo)對(duì)CAP患者進(jìn)行病情判斷及預(yù)后評(píng)估。評(píng)估終點(diǎn)為患者出院或死亡 結(jié)果(1)CAP患者與對(duì)照組之間年齡、性別分布差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(2)與對(duì)照組比較,CAP患者反映凝血功能的指標(biāo)血小板計(jì)數(shù)(PLT)升高(P0.05),凝血酶原時(shí)間(PT)、活化的部分凝血活酶時(shí)間(APTT)纖維蛋白原(Fib)、D-二聚體(D-D)顯著升高(P0.001),凝血酶時(shí)間(TT)差異無統(tǒng)計(jì)學(xué)意義(P0.05)。中高危CAP患者(PSI分級(jí)Ⅳ-Ⅴ級(jí))與低危CAP患者(PSI分級(jí)Ⅰ-Ⅲ級(jí))對(duì)比,PT、TT、D-D顯著升高(P0.001),PLT、APTT、Fib差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(3)CAP組與對(duì)照組比較,PLT、PT、APTT、Fib、D-D異常率差異有統(tǒng)計(jì)學(xué)意義(P0.001),TT異常率差異無統(tǒng)計(jì)學(xué)意義(P0.05)。中高危CAP組與低危CAP組比較,PLT、PT、D-D異常率差異有統(tǒng)計(jì)學(xué)意義(P0.05),TT、APTT、Fib異常率差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(4)中高危CAP患者與低危CAP患者對(duì)比,D-D顯著升高(F=38.441,P0.001),PLT異常率差異無統(tǒng)計(jì)學(xué)意義(P0.05)CAP患者中,D-D升高與PSI分層存在等級(jí)相關(guān)性(r=0.798,P0.001),PLT異常率與PSI分層無關(guān)。(5)CAP患者中合并呼吸衰竭者與無呼吸衰竭者對(duì)比,D-D顯著升高(P0.001),PLT異常率差異無統(tǒng)計(jì)學(xué)意義(P0.05)(6)CAP患者中死亡組與生存組對(duì)比,D-D顯著升高(P0.001),PLT異常率差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(7)使用ROC曲線分析D-D、PSI及PLT異常率對(duì)CAP患者病死率的預(yù)測能力,三者曲線下面積：D-D為0.962,PSI為0.906，PLT為0.583，D-D及PSI二者對(duì)死亡的預(yù)測準(zhǔn)確性高（P㩳0.001），D-D具有較好的敏感性和特異性，其敏感性優(yōu)于特異性。PLT異常對(duì)病死率預(yù)測準(zhǔn)確性欠佳（P㧐0.05）。 結(jié)論1、CAP患者存在PLT計(jì)數(shù)、PT、APTT、Fib、D-D多個(gè)凝血指標(biāo)異常；2、CAP患者血漿D-D顯著升高，且與病情嚴(yán)重程度及病死率呈正相關(guān)，，血漿D-D可作為CAP病情評(píng)估及預(yù)測死亡的良好指標(biāo)。
[Abstract]:Objective to explore the changes of coagulation indexes in community-acquired pneumonias (Caps) patients, and to reveal the value of abnormal coagulation indexes in the diagnosis and prognosis evaluation of CAP, so as to guide the clinical diagnosis and treatment of CAP. Methods 385 patients with CAP from June 2010 to May 2011 in the Department of Respiratory Medicine affiliated to Xiamen University were retrospectively analyzed. 146 patients with infection, tumor, trauma, thrombotic disease and other factors in the same period were taken as the control group. Within 4 hours after admission, peripheral venous blood was collected immediately to detect blood cell count, magnetic beads method was used to detect four items of coagulation, and immunoturbidimetric method was used to detect pneumonia severity index and severity index, PSI) grade in patients with D- dimer CAP. To evaluate the condition and prognosis of CAP patients by the above indexes. Assessment endpoint: discharge or death Results the age of patients with CAP was compared with that of control group. There was no significant difference in sex distribution (P 0.05N. P < 0.05) compared with the control group, the platelet count (PLT) in CAP patients was higher than that in the control group (P 0.05), prothrombin time (PTT), activated partial thromboplastin time (APTT), fibrinogen (Fib) D- dimer (D-D) were significantly higher in CAP patients than in the control group. There was no significant difference in thrombin time (TTT). PSI grade 鈪

本文編號(hào)：1959183