目的 探讨血小板、凝血功能对合并2型糖尿病的脓毒症(sepsis patients with type 2 diabetes mellitus,T2DM-sepsis)患者发生急性肾损伤(acute kidney injury,AKI)的预测价值.方法 选取2015年1月至2021年1月首都医科大学附属北京同仁医院T2DM-sepsis患者257例.根据T2DM-sepsis患者住院期间脓毒症发病7 d内是否发生AKI,将患者分为AKI组与非AKI组.收集两组患者一般资料和临床资料,采用多因素logistic回归方程分析T2DM-sepsis患者发生AKI的影响因素,并采用ROC曲线评估血小板、凝血功能对患者发生AKI的预测价值.结果 257例患者中男146例、女111例,年龄32～101岁,平均(77.4±13.2)岁;发生AKI的患者34例(13.2％).与非AKI组相比,AKI组的序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分、急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)评分、血小板分布宽度(platelet distribution width,PDW)、血小板平均体积(mean platelet volume,MPV)、纤维蛋白原降解产物(fibrinogen degradation products,FDP)和D-二聚体(D-dimer,D-D)均较高,PLT较低,差异均有统计学意义(P<0.05).多因素回归分析结果显示,SOFA评分越高(OR=1.300,95％CI:1.018～1.661,P=0.035)、PDW越高(OR=1.338,95％CI:1.122～1.596,P=0.001)的T2DM-sepsis患者发生AKI的风险越高.SOFA评分和PDW预测患者发生AKI的AUC分别为0.717(95％CI:0.619～0.815,P<0.001)和0.752(95％CI:0.655～0.848,P<0.001).结论 PDW值可作为T2DM-sepsis患者发生AKI风险的评估指标,临床上应特别关注PDW>12.25 fl的T2DM-sepsis患者的治疗和预后.
Predictive value of PLT and coagulation function on acute renal injury in septic patients with type 2 diabetes mellitus
Objective To explore the predictive value of PLT and coagulation function on acute kidney injury (AKI) occured in patients with type 2 diabetes mellitus (T2DM-sepsis). Methods A total of 257 patients with T2DM-sepsis admitted to Beijing Tongren Hospital,Capital Medical University from January 2015 to January 2021 were selected. Patients with TDM-sepsis were divided into the AKI group and non-AKI group according to whether AKI occured within seven days of sepsis during hospitalization. The general and clinical data of the patients were collected,and the influencing factors of AKI in T2DM-sepsis were analyzed by multivariate logistic regression equation,and ROC curve was used to analyze the predictive value of PLT and coagulation function on AKI in patients. Results Among the 257 patients,there were 146 males and 111 females,aged from 32 to 101 years,with an average age of (77.4±13.2) years,and 34 patients (13.2％) developed AKI. Compared with non-AKI group,sequential organ failure assessment (SOFA) score,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score,platelet distribution width (PDW),mean platelet volume (MPV),fibrinogen degradation products (FDP) and D-dimer (D-D) were higher,while PLT was lower in AKI group,and the differences were statistically significant (P<0.05). The multivariate logistic regression analysis results showed that T2DM-sepsis patients with higher SOFA score (OR=1.300,95％CI:1.018-1.661,P=0.035) and higher PDW (OR=1.338,95％CI:1.122-1.596,P=0.001)were more likely to develop AKI. The AUC of SOFA score and PDW for predicting AKI was 0.717(95％CI:0.619-0.815,P<0.001)and 0.752(95％CI:0.655-0.848,P<0.001),respetively. Conclusions PDW can be used as a predictingindicator to evaluate the risk of AKI in patients with T2DM-sepsis. Special attention should be paid to the treatment and prognosis of T2DM-sepsis patients with PDW>12.25 fl.
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