目的 评价快速序贯器官衰竭评分(qSOFA)、可溶性血栓调节蛋白( sTM)、组织纤溶酶原激活物-抑制剂 1 复合物 (t-PAIC)在恶性肿瘤多器官功能衰竭(MOF)患者中的应用价值。 方法 回顾性分析 2022 年 1 月至 12 月北大荒集团总医院确 诊为恶性肿瘤的 240 例患者,其中无器官衰竭患者 125 例(无器官衰竭组),MOF115 例患者,所有入选者均检测 sTM、t - PAIC,并根据实验室检验信息系统 (Laboratory Information System, LIS) 中的信息计算患者 qSOFA 评分及 SOFA 评分。 两组间 非正态分布数据比较采用 Mann-Whitney U 检验,二元多因素 Logistic 回归分析恶性肿瘤患者发生 MOF 的影响因素。 受试者 工作特征曲线(ROC 曲线)判断各指标的诊断效能,约登指数最大处作为最佳截断值。 Kaplan-Meier 方法绘制生存曲线,分析 qSOFA、sTM、t-PAIC 高水平组与低水平组生存率的差异。 结果 发生 MOF 的恶性肿瘤患者 60 d 死亡率,qSOFA 评分,SOFA 评 分,sTM、t-PAIC 显著高于无器官衰竭组,差异有统计学意义(P<0. 001)。 二元多因素 Logistic 回归分析结果显示 sTM、t-PAIC 是恶性肿瘤患者发生 MOF 的危险因素(OR = 1. 750、1. 185,P< 0. 001、P = 0. 003) 。 ROC 曲线分析结果显示,qSOFA、sTM、 t-PAIC 预测恶性肿瘤患者发生 MOF 的截断值分别为 2 分、27. 40 kU/ L、18. 65 μg / L,曲线下面积( AUC) 分别为 0. 815、 0. 848、0. 824。 sTM + t - PAIC 联 合 诊 断 的 效 率 最 高,AUC 为 0. 881。 将 qSOFA ≥2 分、 sTM ≥27. 40 kU/ L, t - PAIC ≥ 18. 65 μg / L 的患者作为高水平组,小于截断值的作为低水平组,Kaplan-Meier 曲线分析结果显示 qSOFA、sTM、t-PAIC 高水 平组患者的总生存率较低水平组显著降低,差异有统计学意义(P = 0. 021、P<0. 001、P<0. 001) 。 结论 发生 MOF 的恶性肿 瘤患者,血浆 sTM、t-PAIC 水平显著升高,是恶性肿瘤患者发生 MOF 的危险因素。 通过实验室无创、快速的检测对发生 MOF 的恶性肿瘤患者提早进行干预,改善肿瘤患者的短期预后。

Objective To evaluate the application value of quick sequential organ failure score qSOFA soluble thrombomodulin sTM tissue plasminogen activator- inhibitor complex t-PAIC in patients with malignant multiple organ failure MOF . Method A retrospective analysis was performed on 240 patients diagnosed with malignant tumor in our hospital including 125 patients without organ failure and 115 patients with multiple organ failure MOF . Mann-Whitney U test was used to compare the two groups and binary Logistics regression was used to analyze the relationship between sTM t-PAIC and MOF in malignant tumor patients. The receiver operating characteristic curve ROC determines the diagnostic efficiency of each index and the maximum Youden index is taken as the best cutoff value. Survival curve was plotted by Kaplan-Meier method to analyze the difference of survival rate among different groups. Result The 60-day mortality qSOFA score SOFA score sTM t-PAIC of malignant tumor patients with MOF were significantly higher than those without organ failure group the difference was statistically significant P < 0. 001 . Binary Logistic regression analysis showed that sTM and t - PAIC were significantly correlated with MOF in patients with malignant tumors OR = 1. 750 1. 185 P<0. 001 P = 0. 003 . ROC curve analysis results showed that the cutoff values of qSOFA sTM and t-PAIC for predicting MOF in malignant tumor patients were 2 27. 40 kU/ L and 18. 65 μg / L respectively and the area under curve AUC were 0. 815 0. 848 and 0. 824 respectively. The combined diagnosis efficiency of sTM + t-PAIC was the highest and the AUC was 0. 881. Patients with qSOFA≥2 sTM≥27. 40 kU/ L t-PAIC≥18. 65 μg / L were taken as the high level group and those with less than cutoff value were taken as the low level group. Kaplan-Meier analysis results showed that the overall survival rate of patients with high level qSOFA sTM t-PAIC was significantly reduced. The difference was statistically significant P = 0. 021 P< 0. 001 P<0. 001 . Conclusion In malignant tumor patients with MOF plasma sTM and t-PAIC levels were significantly increased and were significantly correlated with the prognosis of patients. It is suggested that sTM and t-PAIC should be included in the scoring criteria of SOFA or qSOFA or used as auxiliary diagnosis of SOFA or qSOFA. Early intervention of malignant tumor patients with MOF can improve the short-term prognosis of tumor patients through non-invasive and rapid laboratory detection.