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:

目的 探讨D-二聚体（D-D）、中性粒细胞侧向荧光强度（NE-SFI）联合血栓弹力图（TEG）对重症肺炎患者弥散性血管内凝血前状态（Pre-DIC）的诊断效能及与病情严重程度的相关性。方法 选取2022年1月—2024年1月在温岭市第一人民医院诊疗的重症肺炎并发Pre-DIC的56例患者为观察组，另取同期该院重症肺炎未并发Pre-DIC的56例患者为对照组。比较两组患者血清D-二聚体（D-D）、入院后第1、2、3天连续检测的NE-SFI，以及TEG指标（K值、R值、MA值、α角）、血清凝血酶-抗凝血酶复合物（TAT）、血管性内皮细胞标志物血栓调节蛋白（TM）、α2-纤溶酶抑制物-纤溶酶复合物（PIC）、组织型纤溶酶原激活物抑制物复合物（t-PAIC）、国际血栓与止血学会（ISTH）评分、外周血中性粒细胞胞外诱捕网相关指标［髓过氧化物酶PO（MPO）、双链脱氧核糖核酸（dsDNA）、柠檬酸化组蛋白H3（CitH3）］。采用Spearman法分析D-D、NE-SFI与TEG指标的相关性，采用受试者工作特征（ROC）曲线分析D-D、NE-SFI联合TEG诊断重症肺炎患者Pre-DIC的效能。结果 观察组血小板计数、凝血酶原时间、纤维蛋白原水平、K值和R值均高于对照组（P <0.05），MA值和α角均低于对照组（P <0.05）。死亡组D-D、K值、R值均高于存活组（P <0.05），MA值和α角均低于存活组（P <0.05）。观察组TAT、TM、PIC、t-PAIC水平及ISTH评分、外周血NE-SFI 1、NE-SFI 2、NE-SFI 3、血清MPO、dsDNA、CitH3、D-D水平均高于对照组（P <0.05）。D-D、NE-SFI 1、2、3与K值、R值均呈正相关（P <0.05），D-D、NE-SFI 1、2、3与MA值、α角均呈负相关（P <0.05）。ROC曲线结果分析，D-D、NE-SFI联合TEG诊断重症肺炎患者Pre-DIC的曲线下面积为0.987（95% CI：0.968，1.000），敏感性为94.6%（95% CI：0.851，0.989），特异性为98.2%（95% CI：0.904，1.000），联合诊断价值最高。结论 D-D、NE-SFI联合TEG参数可有效评估重症肺炎患者Pre-DIC状态，其动态变化与凝血功能紊乱程度及预后密切相关。联合检测具有高敏感性与特异性，为临床早期干预提供重要依据。

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.