Objective To investigate clinical characteristics of early period of serious thrombocytopenia (Pit <20.0 × 109/ L) in ICU sepsis patients and catch the condition changes and risk factors in time . Methods Retrospective analysis of the early clinical characteristics of 30 cases of serious thrombocytopenia among sepsis patients in our ICU from Jan 2002 to Dem 2012. And in order to find common ground and differences , compare the data with that of 24 cases of thrombotic purpura (TTP) and 34 cases of DIC from department of hematology in the same period . Data were analyzed by x2 test with SPSS 19.0 software. Results (1) The positive detection of hepatobiliary disease in TTP (18 cases,75% ) and Sepsis (20 cases, 66.7% ) is higher than that of DIC (10 cases,29.4% ) (P <0.01). There is no statistically significant between groups of TTP and Sepsis (P>0.05). (2) The positive detection of hyper - bilirubinemia (TBIL>35 μmol/L) in TTP (17cases,70.8%) and Sepsis (19例,63.3) is higher than that of DIC (8 cases,23.5% ) (P <0.01). There is no statistically significant difference between the groups of TTP and Sepsis (P >0. 05 ). (3) The distribution of APTT < 35 ( s) among groups of TTP(20 cases,87. 5%) and Sepsis(18 cases,60% )is higher than that of DIC (7 cases,20. 6% ) (P <0. 01). But no statistically significant between the groups of TTP and Sepsis (P >0.05). (4) Distribution of patients with first -episode a psychiatric symptoms in groups of TTP ( 22 cases ,91.7%) and Sepsis (21 cases ,70% ) is higher than that of DIC (11 cases,32.4%)(P<0.01). But no statistically significant between the groups of TTP and Sepsis (P>0.025). (5) The survival rate is different between TTP and sepsis , (P <0.01). Conclusion (1) Some clinical characteristics of the sep -sis patients with early serious thrombocytopenia may be similar with that of TTP , but is very different from the presence of DIC. (2) mortality rate of TTP is high, but this study shows that the survival rate of TTP group patients is higher than that of Sepsis group with thrombocytopenia . This may be different because of the two kinds of disease background , but also may be different because of treatment methods , which need to be examined by the future.%目的 对ICU中脓毒症(Sepsis)患者出现血小板严重减少的早期(发现血小板<20.0×109/L的第一时间)某些临床特点做初步分析,以期及时有效地把握疾病的病情变化及危险因素.方法 回顾性分析2002年1月-2012年12月间大连医科大学附属第一医院ICU收治的Sepsis患者中出现血小板严重减少共30例早期的临床特点.并与同期医院血液科收治的血栓性血小板减少性紫癜(thrombotic thrombocytopenic purpura,TTP)患者共24例以及弥散性血管内凝血(disseminated inravascular coagulation,DIC)患者34例的相应资料相比较,以期找到其中的共同点及差异所在.统计学分析采用SPSS19.0软件,采用组间χ2检验.结果 (1)肝胆性基础病在TTP组(18例,75%)与Sepsis组(20例,66.7%)检出率均较高,二组间差异无显著性意义(P>0.05);而在DIC组(10例,29.4%)检出率比前两组低,且差异有显著性意义(P<0.01);(2)患者总胆红素(TBil)>35 μmol/L在TTP组(17例,70.8%)、Sepsis组(19例,63.3%)检出率均较高,二组间差异无显著性意义(P>0.05),DIC组(8例,23.5%)检出率比前两组低,且差异有显著性意义(P<0.01);(3)APTT<35 s在TTP组(20例,83.3%)、Sepsis组(18例,60%)检出率均较高,二组间差异无显著性意义(P>0.05),DIC组(7例,20.6%)检出率比前两组低,且差异显著(P<0.01);(4)在各组病例中伴随血小板减少较早出现意识不清等神志改变的情况在TTP组(22例,91.7%)、Sepsis组(21例,70%)检出率较高,且二组之间无明显差异(P>0.025);而DIC组(11例,32.4%)中发生率较前两组低(P<0.01);(5)血小板减少症在TTP组生存率比Sepsis组高,且差异有著性意义(P<0.01).结论 (1)Sepsis患者血小板严重减少的早期某些临床特点与TTP表现十分相似,而与DIC存在明显不同.(2)TTP本身死亡率虽高,但本研究表明血小板减少症患者在TTP组生存率比Sepsis组高,这可能与二者疾病背景不同有关,也可能与某些治疗手段不同有关,在这一点还需更大的研究加以考察.
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