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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2022, Vol. 15 ›› Issue (02) : 187 -191. doi: 10.3877/cma.j.issn.1674-6902.2022.02.010

论著

凝血功能异常对新冠肺炎重症患者的预后意义
吴文昊1, 王康1, 朱端1, 张厚丽1, 陈俞坊1, 周向东1,†()   
  1. 1. 400038　重庆，陆军（第三）军医大学第一附属医院呼吸与危重症医学科
  • 收稿日期:2021-06-17 出版日期:2022-04-25
  • 通信作者: 周向东

Prognostic significance of abnormal coagulation function in critically ill patients of COVID-19

Wenhao Wu1, Kang Wang1, Duan Zhu1, Houli Zhang1, Yufang Chen1, Xiangdong Zhou1,†()   

  1. 1. Institute of Respiratory Diseases, Department of Respiratory, the First Affiliated Hospital, Army Military Medical University, Chongqing 400038, China
  • Received:2021-06-17 Published:2022-04-25
  • Corresponding author: Xiangdong Zhou
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引用本文：

吴文昊, 王康, 朱端, 张厚丽, 陈俞坊, 周向东. 凝血功能异常对新冠肺炎重症患者的预后意义[J]. 中华肺部疾病杂志(电子版), 2022, 15(02): 187-191.

Wenhao Wu, Kang Wang, Duan Zhu, Houli Zhang, Yufang Chen, Xiangdong Zhou. Prognostic significance of abnormal coagulation function in critically ill patients of COVID-19[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2022, 15(02): 187-191.

目的

分析新型冠状病毒肺炎(corona virus disease 2019, COVID-19)患者凝血功能的临床特征，及其对重症化的预测和预后意义。

方法

收集2020年2月至4月在武汉泰康同济医院确诊的COVID-19患者356例的凝血功能指标，分析其与COVID-19重症化、预后的关联。

结果

356例患者入院时，普通型200例，重型118例，危重38型例。出院时，普通型190例，重型107例，危重型59例。患者凝血酶原时间(prothrombin time, PT)越长、D二聚体越高(D-dimer, DD)D-二聚体越高(D-dimer, D-dimer)、血小板计数越低，诊断为重型和危重型的概率越高(P<0.05)。年龄显著影响重症化(P<0.05，OR＝1.054)，年龄每增加1，重症化概率提升0.054倍。PT能显著影响重症化(P<0.05，OR＝1.245)，PT每提升1，重症化概率提升0.245倍。

结论

高龄、心血管系统基础疾病、PT延长、D二聚体升高，是COVID-19患者重症化的高危因素和预测、预后重要因素。

关键词: 新型冠状病毒肺炎, 凝血功能, 凝血酶原时间, 重症患者
Objective

To analyze the clinical characteristics of blood coagulation function in patients with COVID-19 and its significance in predicting and prognosis of severe symptoms.

Method

The coagulation function data of COVID-19 patients diagnosed in Wuhan Taikang Tongji Hospital from February to April 2020 were collected and their correlation with the severity and prognosis of COVID-19 patients.

Results

A total of 356 patients who met the criteria were collected. at the time of admission, there were 200 cases of common type, 118 cases of severe type and 38 cases of critical type. At discharge, there were 190 cases of common type, 107 cases of severe type and 59 cases of critical type. The critically ill patients with significantly elevated D-dimer and heparin intervention were defined as heparin group, and the critically ill patients with significantly elevated D-dimer without heparin intervention were defined as non-heparin group. There were 53 cases in heparin group and 41 cases in non-heparin group. The longer the prothrombin time (PT), the higher the D-dimer (DD), the higher the D-dimer (D-dimer) and the lower the platelet count, the higher the probability of diagnosis of severe and critical patients. Age could significantly affect the severity of symptoms (P<0.05, OR=1.054), every 1 increase in age increases the probability of severe illness by 0.054 times. PT can significantly affect the severity of symptoms (P<0.05, OR=1.245), for every 1 increase in PT, the probability of severe illness increases by 0.245 times.

Conclusion

COVID-19 patients with advanced age, basic cardiovascular diseases, prolonged PT and elevated D-dimer are all high risk factors for severe illness and important factors for predicting the prognosis of critically ill patients.

Key words: Coronavirus disease 2019, Coagulation function, Prothrombin time, Critically ill patient
表1 各组临床基线特征对比
临床资料 普通(n＝190) 重型(n＝107) 危重型(n＝59) 检验值 P值 未重症化(n＝72) 重症化(n＝22) 检验值 P值
年龄(岁) 62(53~70) 70(62~78) 78(67~87) 61.115 0.000 74(64.5~83.75) 85(76.5~90) -2.636 0.008
住院时间(d) 20(14~23) 17(12~24) 15(12~19) 9.015 0.011 16(11~23) 16(14~22.75) -0.407 0.684
PT(s) 11.8(11~12.5) 12.4(11.6~13.5) 13.1(12.2~14.3) 59.783 0.000 12.95(12~13.98) 14.25(12.85~15.45) -2.743 0.006
INR 1.09(1.02~1.16) 1.15(1.08~1.27) 1.21(1.14~1.32) 60.091 0.000 1.21(1.12~1.32) 1.31(1.19~1.43) -2.39 0.017
Fib-C(mg/dl) 273(239.5~328.25) 323(257~396) 336(294~430) 24.091 0.000 338.68±104.26 376.68±111.9 -1.471 0.145
APTT(s) 31.5(29.7~34.2) 31.3(28.9~33.2) 30.9(27.7~33.8) 3.382 0.184 30.6±4.9 31.88±5.76 -1.029 0.306
TT(s) 15.4(14.4~16.2) 14.9(14.2~16.1) 15.4(14.2~16.7) 2.046 0.36 14.95(14.03~15.98) 16.35(13.98~17) -1.277 0.201
D-dimer(ng/ml) 93.5(56.5~225.25) 464(193~1 383) 709(475~2 536) 144.32 0.000 1 430.5(667.25~2 797.5) 1 129(730~2 743.5) -0.152 0.879
FDP(ng/ml) 1.49(1.06~2.28) 4.13(2.48~11.47) 7.78(4.31~19.33) 146.384 0.000 13.26(6.39~21.31) 11.78(7.66~24.02) -0.045 0.964
PLT(×109/L) 225(180.25~269) 205(164~272) 202(158~242) 7.542 0.023 202.5(155~246.5) 214(161.5~319.5) -1.299 0.194
PDW(%) 11.4(10.4~12.8) 11.5(10.4~13) 12.1(11~13.6) 6.994 0.03 12.1(10.63~13.68) 11.35(10.48~12.3) -1.849 0.064
MPV(fL) 10.3(9.7~11) 10.5(10~11.1) 10.8(10.3~11.5) 19.308 0.000 10.8(10.1~11.6) 10.55(10.18~11.43) -1.05 0.294
P-LCR(%) 26.7(22.18~32.48) 28.1(24.2~32.7) 30.1(27.1~34.7) 13.078 0.001 31.29±8.1 27.83±5.18 2.373 0.021
高血压 67(35.3%) 55(51.4%) 27(45.8%) 7.770 0.021 39(54.2%) 12(54.5%) 0.001 0.975
糖尿病 30(15.8%) 30(28%) 11(18.6%) 6.506 0.039 17(23.6%) 4(18.2%) - 0.772
心血管疾病 21(11.1%) 31(29%) 30(50.8%) 43.259 0.000 33(45.8%) 13(59.1%) 1.185 0.276
肺基础疾病 10(5.3%) 15(14%) 11(18.6%) 11.436 0.003 10(13.9%) 5(22.7%) - 0.331
表2 COVID-19患者出现重症的危险因素
临床资料 重型(参考：普通型) 危重型(参考：普通型)
B P值 OR(95%CI) B P值 OR(95%CI)
年龄 0.02 0.148 1.02(0.993~1.047) 0.045 0.015 1.046(1.009~1.085)
住院时间 0.007 0.739 1.007(0.967~1.048) -0.032 0.234 0.969(0.919~1.021)
凝血酶原时间 0.154 0.038 1.166(1.009~1.348) 0.219 0.011 1.245(1.05~1.475)
纤维蛋白原C 0 0.809 1(0.999~1.002) 0.001 0.568 1.001(0.999~1.002)
活化部分凝血活酶时间 -0.055 0.145 0.947(0.879~1.019) -0.111 0.016 0.895(0.818~0.98)
D二聚体 0.002 <0.001 1.002(1.001~1.002) 0.002 <0.001 1.002(1.001~1.002)
血小板计数 -0.004 0.033 0.996(0.992~1) -0.005 0.035 0.995(0.99~1)
血小板分布宽度 -0.002 0.982 0.998(0.864~1.153) 0.157 0.066 1.17(0.99~1.382)
非高血压 -0.119 0.711 0.888(0.473~1.665) 0.306 0.46 1.358(0.603~3.058)
高血压 0 - - 0 - -
非糖尿病 -0.393 0.277 0.675(0.333~1.371) 0.258 0.603 1.294(0.49~3.418)
糖尿病 0 - - 0 - -
非心血管疾病 -0.38 0.339 0.684(0.314~1.489) -1.139 0.013 0.32(0.13~0.788)
心血管疾病 0 - - 0 - -
非肺部基础疾病 -0.636 0.201 0.53(0.2~1.403) -0.613 0.298 0.542(0.171~1.718)
肺部基础疾病 0 - - 0 - -
表3 重症化的独立影响因素
临床资料 B 标准误差 瓦尔德 P值 OR OR的95%置信区间
下限 上限
年龄 0.053 0.025 4.458 0.035 1.054 1.004 1.107
凝血酶原时间 0.219 0.112 3.853 0.049 1.245 1 1.549
大型血小板比率 -0.088 0.045 3.749 0.053 0.916 0.838 1.001
常量 -5.722 2.525 5.135 0.023 0.003    
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