中国现代医学杂志2025，Vol.35Issue(18)：6-13,8.DOI:10.3969/j.issn.1005-8982.2025.18.002
D-D、NE-SFI、联合TEG对重症肺炎患者弥散性血管内凝血前状态的诊断价值
Diagnostic value of D-Dimer,neutrophil side fluorescence intensity,and thromboelastography for pre-disseminated intravascular coagulation state in patients with severe pneumonia
摘要
Abstract
Objective To investigate the diagnostic efficacy of D-dimer(D-D)and neutrophil side fluorescence intensity(NE-SFI)combined with thromboelastography(TEG)for pre-disseminated intravascular coagulation(pre-DIC)state in patients with severe pneumonia,and to explore their correlation with disease severity.Methods A total of 56 patients with severe pneumonia complicated by pre-DIC admitted to Wenling First People's Hospital from January 2022 to January 2024 were selected as the observation group,and 56 severe pneumonia patients without pre-DIC in the hospital during the same period were selected as the control group.The two groups of patients were compared in terms of serum D-dimer(D-D),consecutive measurements of NE-SFI on days 1,2,and 3 after admission,TEG parameters(K value,R value,MA,and α-angle),serum thrombin-antithrombin complex(TAT),endothelial cell marker thrombomodulin(TM),plasmin-α2-plasmin inhibitor complex(PIC),tissue plasminogen activator-inhibitor complex(t-PAIC),International Society on Thrombosis and Haemostasis(ISTH)score,and neutrophil extracellular trap-related markers in peripheral blood[myeloperoxidase(MPO),double-stranded DNA(dsDNA),and citrullinated histone H3(CitH3)].Spearman's correlation analysis was used to evaluate the relationships of D-D and NE-SFI with TEG parameters,while the receiver operating characteristic(ROC)curve analysis was performed to assess the diagnostic performance of D-D and NE-SFI combined with TEG for predicting pre-DIC in patients with severe pneumonia.Results The observation group had higher platelet count,prothrombin time,fibrinogen level,K value,and R value than the control group(P＜0.05).The MA and α-angle in the observation group were lower than those in the control group(P＜0.05).The death group showed higher D-D levels,K value,and R value,as well as lower MA and α angle compared with the survival group(P＜0.05).The levels of TAT,TM,PIC,and t-PAIC,ISTH scores,peripheral blood NE-SFI on day 1 to 3,and serum levels of MPO,dsDNA,CitH3,and D-D in the observation group were all higher than those in the control group(P＜0.05).The D-D levels and NE-SFI on day 1 to 3 were positively correlated with the K value and R value(P＜0.05),and negatively correlated with the MA and α-angle(P＜0.05).The ROC curve analysis demonstrated that the combined detection of D-D,NE-SFI and TEG yielded the highest diagnostic value,with an AUC of 0.982(95％CI:0.960,1.000),a sensitivity of 96.43％(95％CI:0.877,0.996),and a specificity of 94.6％(95％CI:0.851,0.989).Conclusion D-D and NE-SFI combined with TEG parameters effectively predict the pre-DIC state in patients with severe pneumonia.Their dynamic changes are closely related to the degree of coagulation dysfunction and patient prognosis.The combined detection of these indicators demonstrates high sensitivity and specificity,providing crucial evidence for early clinical intervention.关键词
重症肺炎/弥散性血管内凝血前状态/D-二聚体/血栓弹力图/中性粒细胞侧向荧光强度Key words
severe pneumonia/pre-disseminated intravascular coagulation/D-dimer/thromboelastography/neutrophil side fluorescence intensity分类
医药卫生引用本文复制引用
吴锋,钟丹锋,周素芹..D-D、NE-SFI、联合TEG对重症肺炎患者弥散性血管内凝血前状态的诊断价值[J].中国现代医学杂志,2025,35(18):6-13,8.基金项目
浙江省医药卫生科技计划项目(No:2023KY1049) （No:2023KY1049）
2022年温岭市社会发展科技项目(No:2022S00161) （No:2022S00161）
