解放军医学杂志2024，Vol.49Issue(12)：1372-1378,7.DOI:10.11855/j.issn.0577-7402.1244.2024.0730
不同核心体温的劳力性中暑患者凝血功能变化特征:一项多中心回顾性研究
Changes in coagulation function in patients with exertional heat illness at different core temperatures:a multicenter retrospective study
摘要
Abstract
Objective To investigate the characteristics of coagulation function changes in patients with exertional heat illness(EHI)at different core temperatures(Tc).Methods A retrospective analysis was conducted on the clinical data of 346 EHI patients admitted to the emergency or intensive care units of 24 military hospitals from March 2021 to November 2022.According to the Tc at admission,patients were divided into 4 groups:Tc<39℃group(n=223),39℃≤Tc<40℃group(n=60),40℃≤Tc<41℃group(n=35),41℃≤Tc<42℃group(n=17),and Tc≥42℃group(n=11).Based on the occurrence of heat stroke,the 346 EHI patients were further divided into heat stroke group(n=63)and non-heat stroke group(n=283).Basic information,complete blood count,coagulation function,liver and kidney function,and other laboratory indicators of the patients in each group were collected and statistically analyzed.Multifactorial logistic regression analysis was used to identify independent risk factors for the development of heat stroke in EHI patients.The diagnostic value of prothrombin time(PT),D-dimer,and platelet count for EHI patients developing heat stroke was assessed using the receiver operating characteristic(ROC)curve.Results When Tc exceeded 39℃,D-dimer levels in EHI patients increased significantly and further elevated with rising Tc(P<0.05).When Tc exceeded 40℃,platelet count and fibrinogen levels decreased,and PT was prolonged(P<0.05).When Tc exceeded 41℃,activated partial thromboplastin time(APTT)was significantly prolonged,and platelet count and fibrinogen level decreased(P<0.05).Multivariate logistics regression analysis showed that PT(OR=1.120,95%CI 1.015-1.236),D-dimer(OR=1.322,95%CI 1.129-1.549),and platelet count(OR=0.991,95%CI 0.985-0.997)were independent risk factors for heat stroke(P<0.05).The area under the ROC curve(AUC)for D-dimer in diagnosing heat stroke was 0.796(95%CI 0.732-0.860,P<0.001)with sensitivity and specificity of 69%and 80%,respectively,when D-dimer was greater than 0.9 μg/ml.The AUC for PT in diagnosing heat stroke was 0.708(95%CI 0.628-0.788,P<0.001),with sensitivity and specificity of 42%and 97%,respectively,when PT was greater than 16.4 s.The AUC for platelet count in diagnosing heat stroke was 0.724(95%CI 0.642-0.807,P<0.001),with the sensitivity and specificity of 52%and 94%,respectively,when the platelet count was less than 140×109/L.Conclusions The degree of Tc elevation in EHI patients is positively correlated with the severity of coagulation dysfunction.Prolonged PT,increased D-dimer level,and decreased platelet count are independent risk factors for the development of exertional heat stroke in EHI patients.关键词
劳力性中暑/核心体温/凝血功能/D-二聚体/凝血酶原时间Key words
exertional heat illness/core temperature/coagulation function/D-dimer/prothrombin time分类
医药卫生引用本文复制引用
林青伟,宋景春,宋青,高燕,李海玲,张伟,张玉想,李庆华,全军热射病防治专家组..不同核心体温的劳力性中暑患者凝血功能变化特征:一项多中心回顾性研究[J].解放军医学杂志,2024,49(12):1372-1378,7.基金项目
中国医药教育学会2022科学攻关科研课题(2022KTZ013) This work was supported by the 2022 Scientific Research Project of Chinese Medical Education Society(2022KTZ013) （2022KTZ013）
