肺炎患儿血小板增高的临床意义

The clinical significance of thrombocytosis in pediatric patients with pneumonia

【目的】通过对肺炎伴血小板增多的儿童进行临床特征、实验室指标及潮气通气肺功能检测分析,探讨血小板计数能否作为评判儿童肺炎严重程度和预后的量化指标。【方法】对102例肺炎伴有血小板增多(外周血血小板计数>400×109/L)的患儿(A组)与107例肺炎血小板计数正常的患儿(B组)的临床特点、血实验室生化指标、血浆肿瘤坏死因子-α(TNF-α)和白细胞介素(IL-6)、潮气通气肺功能检测数据进行比较。【结果】与B组比较,A组发生呼吸困难和喘息比例高,住院时间长,白细胞计数高,血浆TNF-α、IL-6的表达增高,代表小气道阻塞的肺功能指标呼气达峰时间(tPTEF)、达峰时间比(呼气达峰时间/呼气时间、tPTEF/tE)、剩余25%潮气量时的呼气流速(TEF25)、剩余25%潮气量时的呼气流速/呼气峰流速(TEF25/PTEF%)降低,差异有统计学意义(P<0.05)。外周血小板计数与IL-6浓度成正相关(r=0.354,P<0.05),与tPTEF/tE、TEF25呈负相关(r=-0.461、-0.407,P<0.05)。【结论】外周血血小板计数升高可作为评判肺炎的炎症反应及病情严重程度的实用参考指标。

[Objective] To analyze the clinical significance of thrombocytosis in pediatric patients with pneumonia. [Methods] 209 patients with pneumonia were divided into 2 groups： 102 patients with thrombocytosis （platelet count〉 400 × 10^9/L, group A）, 107 patients with normal platelet counts （group B）. Clinical data, laboratory data, plasma tumor necrosis factor-α （TNF-α）and interleukin-6（IL-6） concentrations, tidal breathing lung function were compared. [Results] Compared with group B, there were more severe clinical conditions in group A： higher percentage of dyspnea and wheez ing and longer hospitalization, higher white blood count, lower lung function parameter including tPTEF, tPTEF/tE, TEF25 and TEF25/PTEF% ,higher plasma concentrations of TNF-α and IL-6. The difference between the two groups was statistically significant （P〈0.05）. There were positive correlation between plasma concentrations of IL-6 and platelet count （r=0. 354,P〈0.05）. Platelet count was negatively correlated with two kinds of pulmonary function parameters（ tPTEF/ tE,TEF25）（r= -0.461,- 0. 407,P〈0. 05）. [Conclusions] The severity of pneumonia in children is associated with platelet count. Platelet count is a useful clinical marker in judging the severity of pneumonia and guiding therapy.