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| 呼吸道腺病毒7型感染致
凝血筛查指标变化及其对临床分型的诊断价值 |
| Changes in coagulation indicators caused by respiratory human adenovirus-7 infection and its diagnostic value of clinical typing |
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| DOI：10.3969/j.issn.1007-8134.2022.05.006 |
| 中文关键词: 人腺病毒7型 上呼吸道感染 普通肺炎 重症肺炎 凝血功能 D-二聚体 纤维蛋白原降解产物 纤维蛋白原 凝血酶时间 |
| 英文关键词: human adenovirus-7 upper respiratory infection common pneumonia severe pneumonia coagulation function D-dimer fibrinogen degradation product fibrinogen thrombin time |
| 基金项目:国家科技重大专项（2015ZX09J15105-004）；军队后勤科研项目重点项目（BWS14C051-5） |
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| 中文摘要: |
| [摘要] 目的 回顾性分析呼吸道人腺病毒7型（human adenovirus-7, HAdV-7）感染造成凝血筛查指标的变化及其对鉴别患者临床分型的诊断价值。方法 选取2015年1月20日—2月21日我院参与救治的82例呼吸道HAdV-7感染者作为研究对象，根据病情严重程度分为上呼吸道感染（upper respiratory infection, URI）组（42例），普通肺炎（common pneumonia, CP）组（30例）和重症肺炎（severe pneumonia, SP）组（10例），对比分析不同组别患者的一般资料、血常规、凝血筛查指标等。结果 82例患者均为青年男性，平均年龄为（18.8±1.5）岁。3组间凝血酶时间（thrombin time, TT）比较差异有统计学意义，两两比较，SP组较URI组和CP组均有明显延长（P均＜0.05）。3组间D-二聚体（D-dimmer, DD）和纤维蛋白原降解产物（fibrinogen degradation product, FDP）比较差异均有统计学意义，两两比较，SP组DD和FDP较URI组和CP组均有显著升高（P均＜0.05）。TT在鉴别诊断URI和SP时，AUC为0.855（95% CI：0.741～0.968，P＜0.05），在临界值为12.75 s时，其灵敏度为82.8%，特异度为60.4%；TT在鉴别诊断CP和SP时，AUC为0.853（95% CI：0.729～0.976，P＜0.05），在临界值为12.95 s时，其灵敏度为73.3%，特异度为70.0%。DD在鉴别诊断URI和SP时，AUC为0.924（95% CI：0.849～1.000，P＜0.05），在临界值为149.00 μg/L时，其灵敏度为88.9%，特异度为86.5%；DD在鉴别CP和SP时，AUC为0.913（95% CI：0.822～1.000，P＜0.05），在临界值为155.50 μg/L时，其灵敏度为89.5%，特异度为82.4%。FDP在鉴别诊断URI和SP时，AUC为0.861（95% CI：0.755～0.993，P＜0.05），在临界值为2.25 mg/L时，其灵敏度为77.8%，特异度为91.9%；FDP在鉴别诊断CP和SP时，AUC为0.875（95% CI：0.757～0.993，P＜0.05），在临界值为1.55 mg/L时，其灵敏度为84.2%，特异度为76.5%。结论 呼吸道HAdV-7感染可导致患者凝血和纤溶功能出现紊乱。评估、监测凝血筛查指标特别是DD、FDP和TT，对早期识别呼吸道HAdV-7感染高危病例和预测疾病进展，及时干预有重要意义。 |
| 英文摘要: |
| [Abstract] Objective To summarize the changes in coagulation indicators caused by human adenovirus-7(HAdV-7) infection and its diagnostic value of clinical typing with the severity of the disease. Methods Eighty-two patients with HAdV-7 respiratory infection who were treated in our hospital were admitted from January 20 to February 21, 2015. According to the severity of the disease, the patients were assigned upper respiratory infection (URI) group (42 cases), common pneumonia (CP) group (30 cases), and severe pneumonia (SP) group (10 cases). The general information, blood routine, and coagulation indicators of patients in different groups were compared and analyzed. Results All the patients were young men, the mean age was (18.8±1.5) years. There was significant a difference in thrombin time (TT) among the 3 groups, in pairwise comparison, the SP group was significantly longer than the URI group and CP Group (P＜ 0.05). There was a significant difference in D-dimer (DD) and fibrinogen degradation product (FDP) among the 3 groups, in pairwise comparison, DD and FDP in the SP group were significantly higher than the URI group and CP group (P＜0.05). When differentiating URI and SP, the AUC of TT was 0.855 (95% CI: 0.741～0.968, P＜0.05). When the cutoff value was 12.75 s, the sensitivity was 82.8% and the specificity was 60.4%. When distinguishing CP and SP, the AUC of TT was 0.853 (95% CI: 0.729～0.976, P＜ 0.05). When the cutoff value was 12.95 s, the sensitivity was 73.3% and the specificity was 70.0%. When differentiating URI and SP, the AUC of DD was 0.924 (95% CI: 0.849～1.000, P＜0.05), When the cutoff value was 149.00 μg/L, the sensitivity was 88.9%, and the specificity was 86.5%. When distinguishing CP and SP, the AUC of DD was 0.913 (95% CI: 0.822～1.000, P＜ 0.05). When the cutoff value was 155.50 μg/L, the sensitivity was 89.5% and the specificity was 82.4%. When distinguishing URI and SP, the AUC of FDP was 0.861 (95% CI: 0.755～0.993, P＜0.05). When the cutoff value was 2.25 mg/l, the sensitivity was 77.8% and the specificity was 91.9%. When distinguishing CP and SP, the AUC of FDP was 0.875 (95% CI: 0.757～0.993, P＜0.05). When the cutoff value was 1.55 mg/l, the sensitivity was 84.2% and the specificity was 76.5%. Conclusions?HAdV-7 infection can lead to the disorder of coagulation and fibrinolysis function. Evaluating and monitoring coagulation indicators, especially DD, FDP and TT has great significance for early identification, prediction of disease progression and timely intervention of respiratory HAdV -7 infection. |
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