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肾综合征出血热患者病情严重程度的早期指标及基于实验室参数的预后风险模型构建

Early indicators of severity and construction of a risk model for prognosis based upon laboratory parameters in patients with hemorrhagic fever with renal syndrome.

作者信息

Du Hong, Li Jing, Yu Hai-Tao, Jiang Wei, Zhang Ye, Wang Jun-Ning, Wang Ping-Zhong, Bai Xue-Fan

出版信息

Clin Chem Lab Med. 2014 Nov;52(11):1667-75. doi: 10.1515/cclm-2014-0016.

Abstract

BACKGROUND

The objective of this study was to explore the role of laboratory parameters as early indicators of severity and as effective predictors of prognosis in patients with hemorrhagic fever with renal syndrome (HFRS).

METHODS

A total of 356 patients were enrolled in this study and were divided into mild, moderate, severe and critical types according to the clinical classification of HFRS. The levels of 12 routinely tested laboratory parameters during the acute stage among the four types were compared. The predictive values of the laboratory parameters for prognosis were analyzed, and a risk model for prognosis based upon the parameters was constructed.

RESULTS

The levels of white blood counts (WBC), platelets (PLT), aspartate aminotransferase (AST), albumin (ALB), blood urea nitrogen (BUN), serum creatinine (Scr), prothrombin time (PT) and activated partial thromboplastin time (APTT) demonstrated significant differences among the four types (p<0.001); WBC, AST, PT and fibrinogen (Fib) were major independent risk factors for death; WBC, AST, PT and Fib used in combination were better for predicting prognosis than single parameters used alone (p<0.001).

CONCLUSIONS

Some routinely tested laboratory parameters can be beneficial as early indicators of severity of HFRS. Using a combination of WBC, AST, PT and Fib to predict the outcome in patients with HFRS exhibited acceptable diagnostic capability.

摘要

背景

本研究的目的是探讨实验室指标在肾综合征出血热(HFRS)患者中作为病情严重程度早期指标及预后有效预测指标的作用。

方法

本研究共纳入356例患者,根据HFRS的临床分类分为轻症、中症、重症和危重症型。比较四型患者急性期12项常规检测实验室指标的水平。分析实验室指标对预后的预测价值,并构建基于这些指标的预后风险模型。

结果

白细胞计数(WBC)、血小板(PLT)、天门冬氨酸氨基转移酶(AST)、白蛋白(ALB)、血尿素氮(BUN)、血清肌酐(Scr)、凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)在四型之间存在显著差异(p<0.001);WBC、AST、PT和纤维蛋白原(Fib)是死亡的主要独立危险因素;联合使用WBC、AST、PT和Fib预测预后比单独使用单个指标更好(p<0.001)。

结论

一些常规检测的实验室指标可作为HFRS病情严重程度的早期指标。联合使用WBC、AST、PT和Fib预测HFRS患者的预后具有可接受的诊断能力。

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