摘要
目的分析血清D-二聚体对新生儿早发脓毒症患儿预后的预测价值。方法收集2015年4月至2020年4月入住西安交通大学附属儿童医院新生儿重症医学科的189例临床诊断为新生儿早发脓毒症患儿的人口学资料及入院8 h内的临床实验室指标;以入院7 d死亡为终点事件。将D-二聚体≥0.50 mg/L的61例患儿作为观察组,D-二聚体<0.50 mg/L的128例患儿作为对照组。比较对照组与观察组患儿以及各组内不同预后患儿的白细胞计数(WBC)、C-反应蛋白(CRP)、血清降钙素原(PCT)、血乳酸(Lac)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、血小板计数(PLT)、血红蛋白(Hb)、儿科危重症死亡危险评分(PRISMⅢ)、国际血栓形成与止血学会(ISTH)显性弥散性血管内凝血(DIC)评分的差异。采用受试者工作特征曲线(ROC)和ROC曲线下面积(AUC)并联合Logistic回归分析D-二聚体对新生儿早发脓毒症预后的预测价值;根据最佳截断值绘制7 d Kaplan-Meier生存曲线。结果189例患儿中7 d死亡42例,病死率为22.22%。观察组患儿的母源性感染、窒息史、羊水污染、脐带/胎盘病变、胎膜早破发生率以及革兰阴性(G^(-))菌阳性率均明显高于对照组〔母源性感染:34.43%(21/61)比9.38%(12/128),窒息史:34.43%(21/61)比11.72%(15/128),羊水污染:26.23%(16/61)比8.59%(11/128),脐带/胎盘病变:24.59%(15/61)比10.94%(14/128),胎膜早破:29.51%(18/61)比9.38%(12/128),G-菌阳性率:27.87%(17/61)比9.38%(12/128),均P<0.05〕。观察组患儿WBC、PCT、Lac、PT、APTT、PRISMⅢ评分、CRP等均明显高于对照组〔WBC(×10^(9)/L):24.2(4.4,29.4)比21.2(19.1,28.4),PCT(ng/L):67.3±40.4比37.8±25.1,Lac(mmol/L):8.7±7.2比2.3±1.1,PT(s):47.5±12.2比36.6±32.0,APTT(s):85.1±49.6比64.3±29.8,CRP(mg/L):67.8±23.1比41.4±19.6,PRISMⅢ(分):19.5±6.3比10.6±2.1,均P<0.05〕;Fib、PLT、Hb、ISTH显性DIC评分均明显低于对照组〔Fib(g/L):1.5±1.2比2.4±0.8,PLT(×10
Objective To explore the predictive value of serum D-dimer in the prognosis of neonate with early-onset sepsis.Methods The 189 neonates with early-onset sepsis admitted to Neonatal Intensive Care Unit of the Children's Hospital Affiliated to Xi'an Jiaotong University from April 2015 to April 2020 were enrolled and their demographic data and clinical laboratory results within 8 hours after admission were collected;7-day death after admission was taken as end event.According to the different levels of D-dimer,the patients with D-dimer≥0.50 mg/L were assigned in the observation group(61 cases)and those with D-dimer<0.50 mg/L were allowed in the control group(128 cases).The white blood cell count(WBC),C-reactive protein(CRP),serum procalcitonin(PCT),blood lactic acid(Lac),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib),platelet count(PLT),hemoglobin(Hb),pediatric risk mortalityⅢscore(PRISMⅢ)and International Society of Thrombosis and Hemostasis(ISTH)dominant disseminated intravascular coagulation(DIC)score were compared between the observation and control groups and in patients with different prognoses in each group.The predictive value of D-dimer for the prognosis of neonate with early-onset sepsis was verified by the receiver operater characteristic curve(ROC),area under ROC curve(AUC)combined with Logistic regression analysis.According to the best cut-off value,the 7-day Kaplan-Meier survival curve was performed.Results Among the 189 newborns with early-onset sepsis,42 died in 7 days and 7-day mortality was 22.22%.The incidence of maternal infection,history of asphyxia,amniotic fluid pollution,umbilical cord/placenta lesions,premature rupture of membranes and the positive rate of Gram negative(G^(-))bacteria in the observation group were higher than those in the control group,the differences being statistically significant between the two groups[maternal infection:34.43%(21/61)vs.9.38%(12/128),history of asphyxia:34.43%(21/61)vs.11.72%(15/128),amniotic fluid pollution:26.23%(
作者
王义
杨雪峰
田家豪
陆莉
李晓娟
Wang Yi;Yang Xuefeng;Tian Jiahao;Lu Li;Li Xiaojuan(Neonatal Intensive Care Unit,the Children's Hospital Affiliated to Xi'an Jiaotong University,Xi'an 710003,Shaanxi,China;School of Basic Medical Science,the Health Science Center(HSC)of Xi'an Jiaotong University,Xi'an 710061,China;Zhangjiapu Community Health Service Center of Weiyang District,Xi'an 710018,Shaanxi,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2021年第5期518-522,共5页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
陕西省科技厅自然科学基础研究计划面上项目(2020JM-560)
陕西省西安市儿童医院院级科研项目(2020C15)。
