中国输血杂志2025，Vol.38Issue(10)：1340-1347,8.DOI:10.13303/j.cjbt.issn.1004-549x.2025.10.007
外周血中性粒细胞外诱捕网作为标志物对脓毒症相关凝血病的价值研究
The value of peripheral blood neutrophil extracellular traps as a marker for sepsis-induced coagulopathy
摘要
Abstract
Objective To develop a rapid quantification method for neutrophil extracellular traps(NETs)by quantif-ying neutrophils forming NETs(NETotic cells)on routine peripheral blood smears,and to evaluate the performance of an early warning model combining NETs with traditional coagulation indicators for risk of sepsis-induced coagulopathy(SIC)in septic patients.Methods This prospective observational study was conducted in Wuxi People's Hospital Affiliated with Nanjing Medical University between May 2023 and May 2025.A total of 147 patients with sepsis(diagnosed based on Sep-sis-3.0 criteria)who had not developed SIC[the international society on thrombosis and haemostasis(ISTH SIC score<4)]were enrolled.Blood samples were collected within 2 hours of admission.Neutrophil smudge cells(NETs%)were counted using an automated cell morphology analyzer.Serum levels of myeloperoxidase-DNA(MPO-DNA)complexes,cir-culating free DNA(cf-DNA)and sequential organ failure assessment(SOFA)scores were also determined.Based on pro-gression to SIC(ISTH score≥4)within 72 hours of admission,patients were categorized into a sepsis without SIC group(n=85)and a sepsis with SIC group(n=62).Risk factors were analyzed using binary logistic regression,receiver operating characteristic(ROC)curves were plotted,and the predictive value of NETs%,SOFA,and AT-Ⅲ for coagulation dysfunc-tion was assessed.Results The NETs%level was significantly higher in the sepsis with SIC group[8.50%(7.00,11.50)]compared to both the healthy control group[1.00%(0.00,2.00)]and sepsis without SIC group[4.40%(3.50,6.50)](P<0.01).NETs%was identified as an independent risk factor for SIC in sepsis patients.ROC analysis showed that the area under the curve(AUC)for predicting SIC was 0.90 for NETs%,0.85 for MPO-DNA,and 0.79 for cf-DNA.The combined model of NETs%and SOFA score demonstrated the best performance,with an optimal cut-off value of 0.33,an AUC of 0.92,a sensitivity of 77%,and a specificity of 93%.Conclusion NETs%shows promise as a novel biomarker for SIC.Peripheral blood smear morphology provides a simple,rapid,and cost-effective method for quantifying NETs%.NETs%enhances the early clinical identification of patients at high risk for SIC,and its combination with the SO-FA score facilitates SIC prediction,offering a critical time window for initiating timely preventive interventions.关键词
脓毒症/凝血障碍/中性粒细胞外诱捕网/前瞻性队列研究/早期预警Key words
sepsis/coagulation disorders/neutrophil extracellular traps/prospective cohort study/early warning分类
医药卫生引用本文复制引用
戴卓文,熊博钰,潘月月,艾孜买提·艾尔肯,王泽林,王琼..外周血中性粒细胞外诱捕网作为标志物对脓毒症相关凝血病的价值研究[J].中国输血杂志,2025,38(10):1340-1347,8.基金项目
江苏省预防医学面上项目(YM2023008),无锡市"双百"中青年医疗卫生拔尖人才(BJ2023004) （YM2023008）
