摘要目的 探讨常见的几类临床指标在评估热射病患者临床预后中的价值.方法 收集自2008年7月至2014年9月收治余姚市人民医院,入院离发病不超过24h的热射病患者31例.按照患者的临床预后分为存活组和死亡组,比较两组常见几类临床指标的差异并用ROC曲线分析其在评估热射病患者临床预后中的价值.结果 入院体温、乳酸脱氢酶、凝血酶原时间和国际标准化比值在预测热射病患者死亡中的ROC曲线下面积分别是0.808(0.617～0.998)、0.831 (0.686～0.975)、0.831 (0.679 ～0.982)和0.831 (0.673 ～0.989),最佳诊断界值分别是38.65 ℃、892U/L、16.7 s和1.445.格拉斯哥评分和入院纤维蛋白原在预测热射病患者存活中的ROC曲线下面积分别是0.815 (0.664～0.967)和0.885 (0.746～1.000),最佳诊断界值分别是4.5分和2.11g/L.与存活组相比,死亡组入院体温显著升高[(39.4±1.3)℃vs.(37.8±1.1)℃,P=0.01];入院凝血酶原时间显著延长[(24.1±9.5) svs.(17.0±5.2)s,P=0.021];国际标准化比值显著增高[(2.35±1.25) g/L,vs.(1.46±0.63) g/L,P=0.022];纤维蛋白原显著降低[(1.92±0.58)vs.(3.18±1.04),P=0.014].其余观察指标入院APACHEⅡ评分、人院格拉斯哥评分、24 h体温、24 h体温下降幅度、入院乳酸脱氢酶(U/L)、入院肌酸激酶(U/L)、入院活化部分凝血酶原时间、入院乳酸(mmol/L)和入院肌酐(μmol/L)差异无统计学意义.结论 入院体温、乳酸脱氢酶、凝血酶原时间、国际标准化比值、纤维蛋白原和格拉斯哥评分等指标可以有效预测热射病患者的临床预后.

abstractsObjective To investigate and discuss the values of several common clinical biomarkers in assessment of clinical prognosis in patients with heat stroke.Methods Thirty-one patients with heat stroke suffering less than 24 hours treated in our department from July 2008 to September 2014 were enrolled in this study.They were divided into the survival group and death group according to clinical prognosis and then the differences in values of several common clinical biomarkers for assessment of clinical prognosis in patients with heat stroke were compared between two groups using ROC curve analysis.Results ROC areas under the curve (AUC) of body temperature,lactate dehydrogenase (LDH-L),prothrombin time (PT) and international normalized ratio (INR) at admission were 0.808 (0.617-0.998),0.831 (0.686-0.975),0.831 (0.679-0.982) and 0.831 (0.673-0.989),respectively in prediction of deaths in patients with heat stroke and the optimal diagnostic thresholds were 38.65 ℃,892 U/L,16.7s and 1.445,respectively.The ROC AUC of survival in patients with heat stroke predicted by Glasgow Coma Scale and fibrinogen (FIB) were 0.815 (0.664-0.967) and 0.885 (0.746-1.00) respectively and the optimal diagnostic thresholds were 4.5 points and 2.11 g/L.Compared with survival group,in the death group,the admission body temperature group was significantly increased (39.4 ± 1.3 vs.37.8 ± 1.1 ℃,P =0.01),the admission PT was significantly prolonged [(24.1 ± 9.5) s vs.(17.0 ± 5.2) s,P =0.021],the INR was significantly elevated [(2.35 ± 1.25) g/Lvs.(1.46 ±0.63) g/L,P=0.022],and FIB was significantly decreased [(1.92 ±0.58) vs.(3.18 ± 1.04),P =0.014].There were no significantly statistical differences in other biomarkers,including APACHE Ⅰ Score,Glasgow Coma Scale,24-hour body temperature,24-hour temperature decline,LDH-L (U/L),creatine kinase (U/L),PT of activate part,lactic acid (mmol/L) and creatinine (μmol/L) at admission.Conclusions Body temperature,LDH-L,PT,INR,FIB and Glasgow Coma Scale at admission can effectively predict clinical prognosis of the patients with heat stroke.