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目的:探讨新型冠状病毒肺炎（新冠肺炎）患者血清中不同D-二聚体水平与炎性因子及器官功能的关系。方法:采用回顾性研究方法，收集2020年2月10日至29日援鄂期间在华中科技大学同济医学院附属同济医院光谷院区重症病房收治的72例新冠肺炎患者的临床资料，包括一般资料及入院时的血常规、凝血功能、炎性指标、细胞因子和器官功能指标。根据患者D-二聚体水平分为D-二聚体正常（<0.5 mg/L）和升高（≥0.5 mg/L）两组，比较两组患者一般资料、炎性指标和细胞因子水平的差异；采用线性回归法分析D-二聚体与器官功能指标的相关性。以患者初次就诊与入住重症病房时序贯器官衰竭评分的变化值（ΔSOFA）≥2分定义为存在器官功能损伤，绘制受试者工作特征曲线（ROC），评价D-二聚体对新冠肺炎患者器官功能损伤的预测价值。结果:72例患者中有65.3%合并凝血功能异常，D-二聚体水平随病情加重逐渐升高，普通型（14例）、重型（49例）、危重型（9例）分别为0.43（0.22，0.89）、0.66（0.26，1.36）、2.65（0.68，15.45）mg/L，差异有统计学意义（n P<0.05）；其中D-二聚体正常者32例（占44.4%），升高者40例（占55.6%）。与D-二聚体正常组比较，D-二聚体升高组患者年龄更大（岁：67.7±11.6比54.0±13.1），入院时白细胞计数（WBC）、中性粒细胞计数（NEU）、降钙素原（PCT）、超敏C-反应蛋白（hs-CRP）、白细胞介素（IL-6、IL-8、IL-10）、IL-2受体（IL-2R）和肿瘤坏死因子-α（TNF-α）水平更高〔WBC（×10n 9/L）：7.16（5.55，9.75）比5.25（4.59，6.98），NEU（×10n 9/L）：7.11±5.46比3.33±1.58，PCT（μg/L）：0.08（0.06，0.21）比0.05（0.04，0.06），hs-CRP（mg/L）：27.9（3.4，58.8）比1.3（0.8，6.6），IL-6（ng/L）：11.80（2.97，30.61）比1.98（1.50，4.73），IL-8（ng/L）：19.90（13.33，42.28）比9.40（12.35，15.30），IL-10（ng/L）：5.00 （5.00，8.38）比5.00 （5.00，5.00），IL-2R（kU/L）：907.90±458.42比572.13±274.55，TNF-α（ng/L）：10.94±5.95比7.77±3.67〕，淋巴细胞计数（LYM）和单核细胞计数（MON）更低〔LYM（×10n 9/L）：1.14±0.49比1.46±0.42，MON（×10n 9/L）：0.63±0.25比0.87±0.21〕，差异均有统计学意义（均n P<0.05）。线性回归分析显示，D-二聚体水平与脉搏血氧饱和度（SpOn 2）、氧合指数（PaOn 2/FiOn 2）和血小板计数（PLT）均呈显著负相关（β值分别为-0.493、-11.615、-0.018，均n P<0.05），而与呼吸频率（RR）、天冬氨酸转氨酶（AST）、总胆红素（TBil）及直接胆红素（DBil）均呈显著正相关（β值分别为0.485、0.107、0.291、0.404，均n P<0.05）。ROC曲线分析显示，D-二聚体预测新冠肺炎患者器官功能损伤的ROC曲线下面积（AUC）为0.889，95%可信区间（95%n CI）为0.753～1.000；当最佳截断值为2.36 mg/L时，敏感度为85.7%，特异度为78.1%。n 结论:新冠肺炎患者D-二聚体水平与炎性因子和器官功能相关，可以用来预测器官功能损伤。“,”Objective:To explore the relationship between D-dimer concentration and inflammatory factors or organ function in patients with coronavirus disease 2019 (COVID-19).Methods:A retrospective study was conducted. The clinical data of 72 patients with COVID-19 admitted to intensive unit of Tongji Guanggu Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in Wuhan, Hubei Province from February 10th to 29th in 2020 were collected, including their general information, routine blood test, coagulation function, inflammatory parameters, cytokines, and organ function related laboratory parameters at admission. The patients were divided into two groups, namely D-dimer normal group (< 0.5 mg/L) and D-dimer elevated group (≥ 0.5 mg/L). The differences of general data, inflammatory parameters and cytokines between the two groups were compared. Besides, the correlation between D-dimer and organ function was analyzed by linear regression. The change in sequential organ failure assessment (SOFA) between the first visit after the onset of the disease and admission to intensive unit ≥ 2 was defined as being combined with organ damage. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of D-dimer on organ damage in patients with COVID-19.Results:65.3% of the 72 patients had abnormal coagulation. The D-dimer level of COVID-19 patients gradually increased with the aggravation of the disease, and the levels of ordinary type (n n = 14), severe type (n n = 49), and critical type (n n = 9) were 0.43 (0.22, 0.89), 0.66 (0.26, 1.36), and 2.65 (0.68, 15.45) mg/L, respectively, with statistically significant difference (n P < 0.05). Thirty-two patients (44.4%) had normal D-dimer, and 40 (55.6%) had elevated D-dimer. Compared with the normal D-dimer group, the patients in the D-dimer elevated group were older (years old: 67.7±11.6 vs. 54.0±13.1), and the levels of white blood cell count (WBC), neutrophil count (NEU), procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), interleukins (IL-6, IL-8, IL-10), IL-2 receptor (IL-2R) and tumor necrosis factor-α (TNF-α) at admission were significantly higher [WBC (×10 n 9/L): 7.16 (5.55, 9.75) vs. 5.25 (4.59, 6.98), NEU (×10n 9/L): 7.11±5.46 vs. 3.33±1.58, PCT (μg/L): 0.08 (0.06, 0.21) vs. 0.05 (0.04, 0.06), hs-CRP (mg/L): 27.9 (3.4, 58.8) vs. 1.3 (0.8, 6.6), IL-6 (ng/L): 11.80 (2.97, 30.61) vs. 1.98 (1.50, 4.73), IL-8 (ng/L): 19.90 (13.33, 42.28) vs. 9.40 (12.35, 15.30), IL-10 (ng/L): 5.00 (5.00, 8.38) vs. 5.00 (5.00, 5.00), IL-2R (kU/L): 907.90±458.42 vs. 572.13±274.55, TNF-α (ng/L): 10.94±5.95 vs. 7.77±3.67], while lymphocyte (LYM) and monocyte (MON) counts were lower [LYM (×10n 9/L): 1.14±0.49 vs. 1.46±0.42, MON (×10n 9/L): 0.63±0.25 vs. 0.87±0.21], with significant differences (all n P < 0.05). Linear regression analysis showed that D-dimer level was negatively related with pulse oxygen saturation (SpO n 2), oxygenation index (PaOn 2/FiOn 2) and platelet count (PLT) with β values of -0.493, -11.615, and -0.018, respectively (all n P < 0.05). However, D-dimer level was positively related with respiratory rate (RR), aspartate aminotransferase (AST), total bilirubin (TBil) and direct bilirubin (DBil) with β values of 0.485, 0.107, 0.291, and 0.404 (all n P < 0.05). ROC curve analysis showed that the area under ROC curve (AUC) of D-dimer for predicting organ injury in COVID-19 patients was 0.889, and the 95% confidence interval (95% n CI) was 0.753-1.000. When the optimal cut-off value was 2.36 mg/L, the sensitivity was 85.7%, and the specificity was 78.1%.n Conclusion:D-dimer levels in COVID-19 patients are correlated with inflammatory factors and organ function, and it can be used to predict organ injury.