凝血功能指标对危重症患儿的诊断价值-东南大学学报医学版

凝血功能指标对危重症患儿的诊断价值

单位：南京医科大学附属儿童医院检验科, 江苏南京 210008

分类号：R446.111;R459.7

出版年·卷·期（页码）：2019·38·第五期（886-889）

摘要：

目的：观察危重症患儿入院24 h内凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、D-二聚体（DD）、抗凝血酶-Ⅲ（AT-Ⅲ）和血小板（PLT）等指标，探讨凝血功能指标对危重症患儿的临床诊断价值。方法：分析2017年10月至2018年10月南京医科大学附属儿童医院重症监护病房（ICU）住院患儿的临床资料，其中存活78例，死亡35例，选取同时间段内30例健康体检儿童为对照组，结合凝血功能指标进行统计学分析。结果：危重症患儿PT、APTT、FIB、DD、AT-Ⅲ 和PLT受试者工作特征（ROC）曲线下面积（AUC）分别为0.859、0.744、0.868、0.968、0.552和0.836；死亡危重症患儿AUC分别为0.541、0.527、0.617、0.664、0.611、0.597；危重患儿危重程度与PT和DD呈正相关，与AT-Ⅲ呈负相关，与APTT、FIB和PLT无相关性；死亡组的PT、FIB和DD水平高于存活组（P<0.05），存活组和死亡组间APTT、AT-Ⅲ和PLT检测结果差异无统计学意义（P>0.05）；多元进入回归分析结果显示，危重患儿死亡与PT、APTT、FIB和DD相关（P<0.05）。结论：危重患儿PT、APTT、FIB、DD和PLT明显异常，PT、DD和AT-Ⅲ可用于判断其危重程度，PT、APTT、FIB和DD对临床评价危重症患儿预后具有一定的指导价值。

Objective: To explore the diagnostic value of PT, APTT, FIB, DD, AT-Ⅲ and PLT in critically ill children, analyze whether they could evaluate the degree of critically ill children. Methods: The data of patients and healthy controls from October 2017 to October 2018 were retrospectively analyzed using statistical methods. Critically ill children were divided into surviving group and non-surviving group according to the clinical records Results: ROC area under the curve of PT, APTT, FIB, DD, AT-Ⅲ and PLT in critically ill children were 0.859, 0.744, 0.868, 0.968, 0.552 and 0.836, in non-surviving group were 0.541, 0.527, 0.617, 0.664, 0.611 and 0.597, respectively. In surviving group, PT and DD exhibited positive correlation and AT-Ⅲ exhibited negative correlation with the severity of critically ill children, whereas APTT, FIB and PLT presented no relevant. The levels of PT, FIB and DD in non-surviving group were significantly higher than those in surviving group (P<0.05), however, without obvious significance on APTT, AT-Ⅲ and PLT (P>0.05). Multiple entry regression analysis showed that the levels of PT, APTT, FIB, and DD were significantly associated with the mortality of critically ill children(P<0.05). Conclusion: The levels of PT, DD and AT-Ⅲ can be used to determine the critical level; PT, APTT, FIB and DD can be used to evaluate the prognosis in critically ill children.

参考文献：

[1] 张丽丹,黄慧敏,程玉才,等.4种小儿危重死亡评分对危重患儿死亡风险的预测价值[J].中华危重病急救医学,2018,30(1):51-56.
[2] ZHANG X,WANG L,CHEN D C.Effect of rhubarb on gastrointestinal dysfunction in critically ill patients:A retrospective study based on propensity score matching[J].Chin Med J,2018,131:1142-1150.
[3] WADA T,GANDO S,MAEKAW K,et al.Disseminated intravascular coagulation with increased fibrinolysis during the early phase of isolated traumatic brain injury[J].Critl care,2017,21(1):219.
[4] WU Q,REN J,WANG G,et al.Effect of persistent thrombocytopenia on mortality in surgical critically care patients:a retrospective study[J].Clin Appl Thromb Hemost,2017,23(1):84-90.
[5] OH G H,CHUNG S P,PARK Y S,et al.Mean platelet volume to platelet count ratio as a promising predictor of early mortality in severe sepsis[J].Shock,2017,47(3):323-330.
[6] 付鹤鹏,张玉想.危重症患者血小板功能的评估及其临床意义[J].中华危重病急救医学,2018,30(3):284-288.
[7] 胡贵锋,李俊杰,尹文.急重症患者血栓弹力图与传统凝血检查对比研究[J].中华急诊医学杂志,2017,26(9):1043-1049.
[8] HU B,SUN R,WU A,et al.Severity of acute gastrointestinal injury grade is a predictor of all cause mortality in critically patients:A multicenter prospective,observational study[J].Crit Care,2017,21:188.
[9] SHITRIT D,IZBICKI G,SHITRIT A B,et al.Prognostic value of a new quantitative D-dimer test in criticallyly ill patients 24 and 48h following admission to the intensive care unit[J].Blood Coagul Fibrinolysis,2004,15(1):15-19.
[10] DI CASTELNUOVO A,DE CURTIS A,COSTANZO S,et al.Association of D-dimer levels with all-cause mortality in a healthy adult population:findings from the MOLl.SANI study[J].Haematologica,2013,98(9):1476-1480.
[11] BOUDREAU R M,JOHNSON M,VEILE R,et al.Impact of tranexamic acid on coagulation and inflammation in murine models of traumatic brain injury and hemorrhage[J].J Surg Res,2017,215:47-54.

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