中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

血小板白细胞聚集体水平在脓毒症并发急性呼吸窘迫综合征中的诊断价值

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目的探讨脓毒症患者血小板白细胞聚集体(PLA)水平的变化以及对并发急性呼吸窘迫综合征(ARDS)的诊断价值。方法前瞻性研究 2015 年 1 月至 2016 年 12 月入院的成人脓毒症患者。所有脓毒症受检对象检测前不分组,整理资料时按 2012“柏林定义”诊断标准将 58 例脓毒症合并 ARDS 患者作为试验组,139 例脓毒血症非 ARDS 患者作为对照组。诊断脓毒症后即刻采集肘静脉血液样本应用流式细胞术进行 PLA 检测,进行急性生理学和慢性健康状况评分系统 Ⅱ(APACHEⅡ)评分,绘制受试者工作特征(ROC)曲线。结果试验组 PLA、血小板中性粒细胞聚集体(PNA)和血小板淋巴细胞聚集体(PLyA)高于对照组,但差异无统计学意义(均P>0.05)。试验组血小板单核细胞聚集体(PMA)高于对照组,差异有统计学意义(P<0.05)。外周血 PMA 与 APACHEⅡ 评分呈正相关(r=0.671,P<0.001)。以 PMA 为检验变量时,ROC 曲线下面积(AUC)为 0.945,有显著的诊断价值(P<0.001),PMA 最佳临界值为 8.25%,诊断敏感性为 0.806,特异性为 0.951;以 APACHEⅡ 为检验变量时,AUC=0.930,有显著的诊断价值(P<0.001),APACHEⅡ 最佳临界值为 16.500,诊断敏感性为 0.871,特异性为 0.852。结论PMA 对脓毒症合并 ARDS 患者的诊断具有一定价值。

ObjectiveTo investigate the changes of platelet-leukocyte aggregates (PLA) level in patients with sepsis and its diagnostic value in sepsis complicated with acute respiratory distress syndrome (ARDS).MethodsA prospective study was carried in adult sepsis patients admitted to our hospital from January 2015 to November 2016. According to the 2012 " Berlin definition” diagnostic criteria, 58 cases of sepsis with ARDS were allocated to an experimental group and 139 cases of sepsis non-ARDS patients were allocated to a control group. Immediately after the diagnosis of sepsis, elbow vein blood samples were collected for flow cytometry assay of PLA. The acute physiology and chronic health assessment II (APACHE II score) of each group was performed and the receiver operating characteristic (ROC) curve was drawn.ResultsPlatelet-neutrophil aggregates (PNA) and platelet-lymphocyte aggregates (PLyA) in the experimental group were higher than those in the control group, but there were no significant differences (both P>0.05). The platelet-monocyte aggregates (PMA) of the experimental group was significantly higher than that of the control group (P<0.05). Peripheral blood PMA was positively correlated with APACHE II score (r=0.671, P<0.001). When PMA was used as the test variable, the area under the curve (AUC) was 0.945 with significant diagnostic value (P<0.001), and optimal cutoff value of PMA was 8.25%, with diagnostic sensitivity of 0.806 and diagnostic specificity of 0.951. When APACHE II was used as the test variable, AUC was 0.930, with significant diagnostic value (P<0.001), and optimal threshold of APACHE II was 16.500 with diagnostic sensitivity of 0.871 and diagnostic specificity of 0.852.ConclusionPMA is of great value in the diagnosis of sepsis with ARDS.

关键词: 脓毒血症; 急性呼吸窘迫综合征; 血小板白细胞聚集体

Key words: Sepsis; Acute respiratory distress syndrome; Platelet-leukocyte aggregates

引用本文: 蒋涵, 贾超. 血小板白细胞聚集体水平在脓毒症并发急性呼吸窘迫综合征中的诊断价值. 中国呼吸与危重监护杂志, 2018, 17(1): 42-45. doi: 10.7507/1671-6205.201705039 复制

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