降钙素原与血小板比值评估发热伴血小板减少综合征预后的价值

doi:10.3969/j.issn.1004-583X.2023.04.010

摘要/Abstract

摘要：

目的探讨降钙素原血小板比值(procalcitonin/platelet ratio,PCT/PLT)评估发热伴血小板减少综合征(Severe fever with thrombocytopenia syndrome,SFTS)预后的价值。方法收集威海市中心医院2020年1月1日至2022年1月1日确诊的SFTS住院患者156例,根据患者预后分为死亡组与存活组。对比两组基本资料以及化验室指标,通过Logistic回归筛选影响SFTS预后的独立危险因素,通过ROC曲线下面积、敏感度、特异度、准确度等评价不同影响因素对于SFTS预后的价值。结果死亡组中活化部分凝血活酶时间、凝血酶时间、D-二聚体、丙氨酸氨基转移酶、血清肌酐、乳酸脱氢酶、天门冬氨酸氨基转移酶、血尿素氮、活化部分凝血活酶时间/血小板、中性粒细胞计数、中性粒细胞淋巴细胞比值、肌酸激酶同工酶、降钙素原、PCT/PLT、病毒核酸定量等高于最佳参考值的患者占比明显高于存活组,差异有统计学意义(P<0.05),而Ca²⁺、PLT、淋巴细胞计数等高于最佳参考值的患者占比明显低于存活组,差异有统计学意义(P<0.05)。单因素以及二项多元Logistic回归显示,年龄、凝血酶时间、天门冬氨酸氨基转移酶、淋巴细胞计数、PCT/PLT、病毒核酸定量可作为影响SFTS预后的独立危险因素。PCT/PLT最佳参考值为0.005,AUC为0.828(0.757~0.898),当PCT/PLT大于0.005时,患者死亡风险增加30倍,敏感度为87.1%、特异度为78.4%。结论 PCT/PLT可作为评估SFTS患者预后的临床指标。

关键词: 重度发热伴血小板减少综合征, 白蛉病毒, 降钙素原, 血小板, 死亡, 预后

Abstract:

Objective To investigate the value of procalcitonin/platelet ratio(PCT/PLT) in evaluating the prognosis of Severe fever with thrombocytopenia syndrome(SFTS). Methods A total of 156 SFTS patients diagnosed in Weihai Central Hospital from January 1, 2020 to January 1, 2022 were collected andassigned into death group and survival group according to the prognosis. the basic data and laboratory indicators of the two groups were compared, the independent risk factors affecting the prognosis of SFTS were screened by univariate and binomial multiple Logistic regression, and the value of different influencing factors on the prognosis of SFTS was evaluated by the area under the receiver operating characteristic(ROC) curve, sensitivity, specificity, accuracy.Results Activated partial thromboplastin time, thrombin time, D-dimer, alanine aminotransferase, serum creatinine, lactate dehydrogenase, aspartate aminotransferase, blood urea nitrogen, activated partial thromboplastin time/platelet, neutrophil count, neutrophil lymphocyte ratio, creatine kinase isoenzyme, procalcitonin, PCT/PLT, as well as the proportion of patients whose nucleic acid quantity were higher than the optimal reference value in the death group was significantly higher than those in the survival group(P<0.05). The proportion of patients with Ca²⁺, PLT, lymphocyte count higher than the optimal reference value was significantly lower than that in the survival group(P<0.05). Univariate and binomial multiple Logistic regression showed that age, thrombin time, aspartate aminotransferase, lymphocyte count, PCT/PLT, and viral nucleic acid quantification were independent risk factors for the prognosis of SFTS. The best reference value of PCT/PLT was 0.005, and the AUC was 0.828(0.757-0.898). When PCT/PLT was greater than 0.005, the risk of death was increased by 30 times, the sensitivity was 87.1%, and the specificity was 78.4%. Conclusion PCT/PLT can be used as a clinical indicator to evaluate the prognosis of patients with SFTS.

Key words: severe fever with thrombocytopenia syndrome, phlebotomus virus, procalcitonin, platelets, death, prognosis

中图分类号:

R558.2

杨金强, 张仁敏. 降钙素原与血小板比值评估发热伴血小板减少综合征预后的价值[J]. 临床荟萃, 2023, 38(4): 346-351.

Yang Jinqiang, Zhang Renmin. Prognostic value of procalcitonin to platelet ratio in patients with fever with thrombocytopenia syndrome[J]. Clinical Focus, 2023, 38(4): 346-351.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.04.010

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I4/346

图/表 5

参考文献 18

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项目	存活组(n=125)	死亡组(n=31)	P值	Z值/χ²值
年龄[Q2(Q1, Q3)]	66.00(61.00, 71.00)	71.00(66.50, 78.00)	0.001	3.302
性别[例(%)]
男女	58(46.4) 67(53.6)	15(48.4) 16(51.6)	0.843	0.039
APTT[例(%)]
≤43.4 s >43.4 s	107(85.6) 18(14.4)	14(45.2) 17(54.8)	0.001	23.343
TT[例(%)]
≤19.4 s >19.4 s	75(60.0) 50(40.0)	7(22.6) 24(77.4)	0.001	13.949
DD[例(%)]
≤1.89 mg/L >1.89 mg/L	79(63.2) 46(36.8)	10(32.3) 21(67.7)	0.002	9.706
ALT[例(%)]
≤107 U/L >107 U/L	92(73.6) 33(26.4)	14(45.2) 17(54.8)	0.002	9.224
SCR[例(%)]
≤95 μmol/L >95 μmol/L	110(88.0) 15(12.0)	17(54.8) 14(45.2)	0.001	18.049
LDH[例(%)]
≤1282 U/L >1282 U/L	102(81.6) 23(18.4)	11(35.5) 20(64.5)	0.001	26.458
AST[例(%)]
≤326 U/L >326 U/L	99(79.2) 26(20.8)	13(41.9) 18(58.1)	0.001	17.034
BUN[例(%)]
≤6.8 mmol/L >6.8 mmol/L	81(64.8) 44(35.2)	7(22.6) 24(77.4)	0.001	18.006
Ca²⁺[例(%)]
≤1.91 mmol/L >1.91 mmol/L	46(36.8) 79(63.2)	20(64.5) 11(35.5)	0.005	7.818
WBC[例(%)]
≤2.91×10⁹/L >2.91×10⁹/L	82(65.6) 43(34.4)	24(80.0) 6(20.0)	0.128	2.321
PLT[例(%)]
≤60×10⁹/L >60×10⁹/L	57(45.6) 68(54.4)	26(83.9) 5(16.1)	0.001	14.613
APTT/PLT[例(%)]
≤0.7 >0.7	78(62.4) 47(37.6)	5(16.1) 26(83.9)	0.001	21.361
NC[例(%)]
≤0.66×10⁹/L >0.66×10⁹/L	28(22.4) 97(77.6)	0(0) 31(100.0)	0.004	8.463
LC[例(%)]
≤0.44×10⁹/L >0.44×10⁹/L	47(37.6) 78(62.4)	18(58.1) 13(41.9)	0.039	4.280
NLR[例(%)]
≤1.35 >1.35	30(24.0) 95(76.0)	1(3.2) 30(96.8)	0.009	6.732
PLR[例(%)]
≤152.4 >152.4	74(59.2) 51(40.8)	23(74.2) 8(25.8)	0.123	2.375
CK-MB[例(%)]
≤23.1 U/L >23.1 U/L	65(52.0) 60(48.0)	6(19.4) 25(80.6)	0.001	10.675
PCT[例(%)]
≤0.25 ng/ml >0.25 ng/ml	93(74.4) 32(25.6)	7(22.6) 24(77.4)	0.001	28.986
PCT/PLT[例(%)]
≤0.005 >0.005	98(78.4) 27(21.6)	4(12.9) 27(87.1)	0.001	47.081
病毒核酸定量[例(%)]
≤12 000 >12 000	110(88.0) 15(12.0)	6(19.4) 25(80.6)	0.001	46.317
发热[例(%)]
否是	22(17.6) 103(82.4)	11(35.5) 20(64.5)	0.129	4.763
咳嗽[例(%)]
否是	113(90.4) 12(9.6)	30(96.8) 1(3.2)	0.467	0.263
消化道症状[例(%)]
否是	74(59.2) 51(40.8)	17(54.8) 14(45.2)	0.659	0.194
周身乏力[例(%)]
否是	34(27.2) 91(72.8)	10(32.3) 21(67.7)	0.575	0.314

项目	存活组(n=125)	死亡组(n=31)	P值	Z值/χ²值
年龄[Q2(Q1, Q3)]	66.00(61.00, 71.00)	71.00(66.50, 78.00)	0.001	3.302
性别[例(%)]
男女	58(46.4) 67(53.6)	15(48.4) 16(51.6)	0.843	0.039
APTT[例(%)]
≤43.4 s >43.4 s	107(85.6) 18(14.4)	14(45.2) 17(54.8)	0.001	23.343
TT[例(%)]
≤19.4 s >19.4 s	75(60.0) 50(40.0)	7(22.6) 24(77.4)	0.001	13.949
DD[例(%)]
≤1.89 mg/L >1.89 mg/L	79(63.2) 46(36.8)	10(32.3) 21(67.7)	0.002	9.706
ALT[例(%)]
≤107 U/L >107 U/L	92(73.6) 33(26.4)	14(45.2) 17(54.8)	0.002	9.224
SCR[例(%)]
≤95 μmol/L >95 μmol/L	110(88.0) 15(12.0)	17(54.8) 14(45.2)	0.001	18.049
LDH[例(%)]
≤1282 U/L >1282 U/L	102(81.6) 23(18.4)	11(35.5) 20(64.5)	0.001	26.458
AST[例(%)]
≤326 U/L >326 U/L	99(79.2) 26(20.8)	13(41.9) 18(58.1)	0.001	17.034
BUN[例(%)]
≤6.8 mmol/L >6.8 mmol/L	81(64.8) 44(35.2)	7(22.6) 24(77.4)	0.001	18.006
Ca²⁺[例(%)]
≤1.91 mmol/L >1.91 mmol/L	46(36.8) 79(63.2)	20(64.5) 11(35.5)	0.005	7.818
WBC[例(%)]
≤2.91×10⁹/L >2.91×10⁹/L	82(65.6) 43(34.4)	24(80.0) 6(20.0)	0.128	2.321
PLT[例(%)]
≤60×10⁹/L >60×10⁹/L	57(45.6) 68(54.4)	26(83.9) 5(16.1)	0.001	14.613
APTT/PLT[例(%)]
≤0.7 >0.7	78(62.4) 47(37.6)	5(16.1) 26(83.9)	0.001	21.361
NC[例(%)]
≤0.66×10⁹/L >0.66×10⁹/L	28(22.4) 97(77.6)	0(0) 31(100.0)	0.004	8.463
LC[例(%)]
≤0.44×10⁹/L >0.44×10⁹/L	47(37.6) 78(62.4)	18(58.1) 13(41.9)	0.039	4.280
NLR[例(%)]
≤1.35 >1.35	30(24.0) 95(76.0)	1(3.2) 30(96.8)	0.009	6.732
PLR[例(%)]
≤152.4 >152.4	74(59.2) 51(40.8)	23(74.2) 8(25.8)	0.123	2.375
CK-MB[例(%)]
≤23.1 U/L >23.1 U/L	65(52.0) 60(48.0)	6(19.4) 25(80.6)	0.001	10.675
PCT[例(%)]
≤0.25 ng/ml >0.25 ng/ml	93(74.4) 32(25.6)	7(22.6) 24(77.4)	0.001	28.986
PCT/PLT[例(%)]
≤0.005 >0.005	98(78.4) 27(21.6)	4(12.9) 27(87.1)	0.001	47.081
病毒核酸定量[例(%)]
≤12 000 >12 000	110(88.0) 15(12.0)	6(19.4) 25(80.6)	0.001	46.317
发热[例(%)]
否是	22(17.6) 103(82.4)	11(35.5) 20(64.5)	0.129	4.763
咳嗽[例(%)]
否是	113(90.4) 12(9.6)	30(96.8) 1(3.2)	0.467	0.263
消化道症状[例(%)]
否是	74(59.2) 51(40.8)	17(54.8) 14(45.2)	0.659	0.194
周身乏力[例(%)]
否是	34(27.2) 91(72.8)	10(32.3) 21(67.7)	0.575	0.314

项目	回归系数	标准误	Z值	Wald χ²值	OR值	P值	95%CI
项目	回归系数	标准误	Z值	Wald χ²值	OR值	P值	下限	上限
年龄	0.084	0.026	3.247	10.543	1.088	0.001	1.034	1.145
APTT(>43.4 s)	-1.977	0.442	4.474	20.020	7.218	0.001	3.037	17.158
TT(>19.4 s)	1.638	0.467	3.509	12.310	5.143	0.001	2.060	12.838
DD(>1.89 mg/L)	1.283	0.427	3.007	9.040	3.607	0.003	1.563	8.322
ALT(>107 U/L)	1.219	0.414	2.945	8.675	3.385	0.003	1.504	7.621
SCR(>95 μmol/L)	1.798	0.454	3.962	15.697	6.039	0.001	2.481	14.701
LDH(>1282 U/L)	2.087	0.441	4.737	22.439	8.063	0.001	3.400	19.125
AST(>326 U/L)	1.662	0.425	3.907	15.266	5.272	0.001	2.290	12.139
BUN(>6.8 mmol/L)	1.842	0.469	3.932	15.458	6.312	0.001	2.519	15.814
Ca²⁺(≤1.91 mmol/L)	-1.139	0.419	-2.720	7.396	0.320	0.007	0.141	0.728
PLT(≤60×10⁹/L)	-1.825	0.520	-3.508	12.305	0.161	0.001	0.058	0.447
APTT/PLT(>0.7)	2.155	0.522	4.128	17.042	8.630	0.001	3.102	24.010
LC(≤0.44×10⁹/L)	-0.832	0.408	-2.038	4.155	0.435	0.042	0.196	0.968
NLR(>1.35)	2.249	1.038	2.166	4.694	9.474	0.030	1.239	72.440
CK-MB(>23.1 U/L)	1.507	0.489	3.085	9.516	4.514	0.002	1.732	11.761
PCT(>0.25 ng/ml)	2.299	0.476	4.830	23.333	9.964	0.001	3.920	25.327
PCT/PLT(>0.005)	3.199	0.578	5.532	30.608	18.500	0.001	7.889	50.087
病毒核酸定量(>12 000)	3.420	0.531	6.435	41.405	20.556	0.001	10.783	64.586

项目	回归系数	标准误	Z值	Wald χ²值	OR值	P值	95%CI
项目	回归系数	标准误	Z值	Wald χ²值	OR值	P值	下限	上限
年龄	0.084	0.026	3.247	10.543	1.088	0.001	1.034	1.145
APTT(>43.4 s)	-1.977	0.442	4.474	20.020	7.218	0.001	3.037	17.158
TT(>19.4 s)	1.638	0.467	3.509	12.310	5.143	0.001	2.060	12.838
DD(>1.89 mg/L)	1.283	0.427	3.007	9.040	3.607	0.003	1.563	8.322
ALT(>107 U/L)	1.219	0.414	2.945	8.675	3.385	0.003	1.504	7.621
SCR(>95 μmol/L)	1.798	0.454	3.962	15.697	6.039	0.001	2.481	14.701
LDH(>1282 U/L)	2.087	0.441	4.737	22.439	8.063	0.001	3.400	19.125
AST(>326 U/L)	1.662	0.425	3.907	15.266	5.272	0.001	2.290	12.139
BUN(>6.8 mmol/L)	1.842	0.469	3.932	15.458	6.312	0.001	2.519	15.814
Ca²⁺(≤1.91 mmol/L)	-1.139	0.419	-2.720	7.396	0.320	0.007	0.141	0.728
PLT(≤60×10⁹/L)	-1.825	0.520	-3.508	12.305	0.161	0.001	0.058	0.447
APTT/PLT(>0.7)	2.155	0.522	4.128	17.042	8.630	0.001	3.102	24.010
LC(≤0.44×10⁹/L)	-0.832	0.408	-2.038	4.155	0.435	0.042	0.196	0.968
NLR(>1.35)	2.249	1.038	2.166	4.694	9.474	0.030	1.239	72.440
CK-MB(>23.1 U/L)	1.507	0.489	3.085	9.516	4.514	0.002	1.732	11.761
PCT(>0.25 ng/ml)	2.299	0.476	4.830	23.333	9.964	0.001	3.920	25.327
PCT/PLT(>0.005)	3.199	0.578	5.532	30.608	18.500	0.001	7.889	50.087
病毒核酸定量(>12 000)	3.420	0.531	6.435	41.405	20.556	0.001	10.783	64.586

项目	回归系数	标准误	Z值	Wald χ²值	OR值	P值	95%CI
项目	回归系数	标准误	Z值	Wald χ²值	OR值	P值	下限	上限
年龄	0.127	0.054	2.329	5.425	1.135	0.020	1.020	1.263
TT(>19.4 s)	2.574	1.297	1.985	3.941	13.121	0.047	1.033	166.649
AST(>326 U/L)	2.676	1.221	2.192	4.803	14.527	0.028	1.327	159.061
LC(≤0.44×109/L)	-2.616	1.098	-2.381	5.671	0.073	0.017	0.008	0.630
PCT/PLT(>0.005)	3.769	1.154	3.266	10.664	30.327	0.001	4.512	416.055
病毒核酸定量(>12 000)	3.940	1.016	3.878	15.041	38.407	0	7.019	376.477