摘要
目的 探讨出生1周内血小板参数预测有血流动力学意义的动脉导管未闭（haemodynamically significant patent ductus arteriosus,hsPDA）早产儿药物干预失败的价值.方法 选择2010年11月至2016年7月本院儿童诊疗中心新生儿重症监护病房收治的hsPDA早产儿.2010年11月至2012年10月口服布洛芬治疗,2012年11月至2016年7月口服布洛芬或对乙酰氨基酚治疗,均在治疗72 h后复查超声心动图,动脉导管完全闭合为治疗成功组,未完全闭合为失败组.应用受试者工作特征曲线分析血小板参数预测早产儿hsPDA药物干预失败的价值,并对早产儿hsPDA药物干预失败进行多因素分析.结果 最终纳入107例hsPDA早产儿,其中治疗成功组（76例）胎龄（32.6±1.9）周,出生体重（1834±447）g,均高于失败组（31例）的（30.6±2.6）周和（1397±537）g.治疗成功组生后第4-7天血小板压积高于失败组（0.21%±0.13%比0.15%±0.07%）,差异有统计学意义（P=0.024）.多因素回归分析显示,出生体重低、合并呼吸窘迫综合征和生后第4-7天血小板压积低是hsPDA早产儿药物干预失败的独立危险因素.生后第4-7天血小板压积预测早产儿hsPDA药物干预失败的受试者工作特征曲线下面积为0.630（95%CI 0.502-0.757,P=0.036）,最佳预测界值为0.125%,敏感度35.5%,特异度92.1%.结论 出生体重低、合并呼吸窘迫综合征和生后第4-7天血小板压积低是hsPDA早产儿药物干预失败的独立危险因素.生后第4-7天血小板压积对早产儿hsPDA药物干预失败有一定预测价值,但预测价值较低.
Objective To study the value of platelet parameters within the first week of life in predicting drug intervention failure of haemodynamically significant patent ductus arteriosus （ hsPDA ） in preterm infants.Method The preterm infants admitted to NICU of the Affiliated Xuzhou Hospital to the Southeast University from Nov 2010 to Jul 2016 were studied.All preterm infants with hsPDA were treated with ibuprofen or acetaminophen , and were assigned into the success group and the failure group .The following data were retrospectively collected： platelet parameters included platelet counts , plateletocrit , platelet distribution width , mean platelet volume , and platelet-large cell ratio in blood cell analysis of venous blood in the first 24 hours and the 4-7 days of life.Echocardiography was done 72 hours after the usage of ibuprofen or acetaminophen treatment .Result There were 107 preterm infants with hsPDA in our study , 76 infants in the success group and 31 infants in the failure group.Among the platelet parameters in the first 24 hours and the 4-7 days of life, there were significant difference only in the plateletocrit in the 4-7 days after birth between the success group and the failure group （ 0.21%±0.13% vs.0.15%±0.07%, P=0.024）.The smaller birth weight , the respiratory distress syndrome , and the smaller plateletocrit in the 4-7 days of life were the independent risk factors for the drug intervention failure of hsPDA in preterm infants .The area under the receiver operating characteristic curves of the plateletocrit in the 4 -7 days of life for predicting the drug intervention failure of hsPDA in preterm infants was 0.630 （95%CI 0.502-0.757, P=0.036）.The best prediction cutoff value of the plateletocrit in the 4-7 days of life was 0.125%（sensitivity was 35.5%, specificity was 92.1%） .Conclusion The smaller birth weight , with respiratory distress syndrome, and the smaller plateletocrit in the 4-7 days of life were the independent risk factors of the drug intervention failure of hsPDA i
基金
江苏省青年医学人才（QNRC2016385）
江苏省妇幼健康科研项目（新生儿医学F201645）
徐州市科技局科研项目（社会发展KC16SL097）
关键词
血小板
动脉导管未闭
婴儿
早产
治疗失败
Blood platelets
Ductus arteriosus
patent
Infant
premature
Treatment failure
