王武超 曹宝平

DOI：10.3760/cma.j.issn.1671-0282.2014.08.017

作者單位：100044 北京，北京大学人民医院急诊科

通信作者：曹宝平，Email：bpcao811@163.com

【摘要】目的 探讨脓毒症患者纤维蛋白原/C反应蛋白（fibrinogen/CRP）比值水平与弥漫性血管内凝血（DIC）发生的相关性。

访法 选择北京大学人民医院急诊重症监护病房脓毒症患者共61例，收入急诊重症监护病房24 h内进行血常规、CRP、血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原、D-二聚体（D-dimer）水平的检测。收集纳入研究患者的临床资料，进行APACHE Ⅱ评分、ISTH的DIC评分及JAAM的DIC评分。根据DIC评分结果将患者分为DIC组和非DIC组，对比组间血小板、CRP、血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原水平（FIB）、Fibrinogen/CRP比值，并建立ROC曲线明确CRP， Fibrinogen/CRP比值对于诊断DIC的敏感性及特异性。计算CRP， Fibrinogen/CRP与JAAM评分诊断DIC的OR值。所有数据采用SPSS 17.0版统计软件进行分析。

结果 ①DIC组Fibrinogen/CRP比值明显低于非DIC组。②ISTH的DIC评分：Fibrinogen/CRP比值ROC曲线下为0.691，高于C反应蛋白ROC曲线下0.561，纤维蛋白原ROC曲线下0.608。③JAAM的DIC评分：Fibrinogen/CRP比值ROC曲线下为0.814，高于C反应蛋白ROC曲线下0.788，纤维蛋白原ROC曲线下为0.429。④JAAM评分诊断DIC：Fibrinogen/CRP比值（<45）OR值为11.14，CRP （>70 mg/l） OR值为8.05。

结论 Fibrinogen/CRP比值可以作为脓毒症患者DIC诊断的早期判读指标。

【关键词】脓毒症；弥漫性血管内凝血；C反应蛋白；纤维蛋白原/ C反应蛋白比值

Fibrinogen/C reactive protein ratio as a parameter for diagnosis of disseminated intravascular coagulation in patients with sepsis.Wuchao Wang， Baoping Cao. Department of Emergency， Peking University Peoples Hospital， Beijing 100044 ， China

Corresponding atuhor：Cao Baoping，Email：bpcao811@163.com

【Abstract】Objective To determine if the fibrinogen/C reactive protein （CRP） ratio could be used in sepsis patients as a predictor for disseminated intravascular coagulation. Methods A total of 61 patients with sepsis admitted to emergency intensive care unit （EICU） were enrolled. C reactive protein （CRP） and variables of coagulation such as Platelet （PLT）， prothrombin time （PT）， activated partial thrombopastin time （APTT）， fibrinogen and D-dimer were analyzed during 24 hours after admission to EICU. APACHE Ⅱ score， ISTH score and JAAM score were evaluated. According to DIC score （JAAM score and ISTH score）， the patients were divided into two groups： overt DIC and no overt DIC. Data were expressed in mean±standard deviation and were statistically analyzed by SPSS 17.0. The differences of CRP， PLT， PT， APTT， fibrinogen and D-dimer of patients in each group were analyzed by independent samples t test. The receiver-operating characteristics （ROC） analysis was performed to predict the diagnostic power of the variables fibrinogen， CRP， and fibrinogen/C reactive protein （CRP） ratio. In addition， the odds ratios （OR） were estimated by chi-square test and the 95% confidence intervals were calculated. Results In overt DIC group fibrinogen/C reactive protein （CRP） ratio was significantly lower. The receiver-operating characteristic analysis showed for the fibrinogen/C reactive protein （CRP） ratio （area under the curve： ISTH criteria 0.691 and JAAM criteria 0.814） significantly better discriminative power than for fibrinogen （area under the curve： ISTH criteria 0.608 and JAAM criteria 0.429） and CRP（area under the curve： ISTH criteria 0.561 and JAAM criteria 0.788）. The odds ratio for fibrinogen/C reactive protein （CRP） ratio （<45） was 11.14 and CRP （>70 mg/L） was 8.05. Conclusions We suggest that the fibrinogen/C reactive protein （CRP） ratio could be a diagnostic factor for the occurrence of disseminated intravascular coagulation in sepsis patients.

【Key words】Sepsis； Disseminated intravascular coagulation ； C reactive protein ； Fibrinogen/C reactive proteinratio

脓毒症和脓毒症所致的多脏器功能衰竭对于临床医生而言是重要的挑战，尽管关于脓毒症的研究众多，但是脓毒症所导致的住院率和病死率仍逐年升高^[1]。脓毒症炎症反应的主要特征是炎症反应介质在局部和全身释放以及血管屏障功能破坏。早期炎症反应可以激活凝血系统，启动凝血级联反应，同时生理性纤溶途径被抑制，血管内广泛微血栓形成自发纤溶途径受到抑制，将导致微循环障碍，组织缺血缺氧，微循环灌注障碍与器官功能衰竭明显相关^[2]，故尽早全面诊断与治疗是很重要的^[3]。……