血小板相关指标对早产儿有血流动力学意义的动脉导管未闭的早期预测价值

The predictive value of platelet associated indicators on hemodynamically significant patent ductus arteriosus in preterm infants

目的探讨血小板相关指标对早产儿有血流动力学意义的动脉导管未闭的早期预测价值。方法回顾性分析2015年1月至2016年12月本院新生儿科收治的120例动脉导管未闭早产儿,纳入有血流动力学意义的动脉导管未闭(hemodynamically significant patent ductus arteriosus,hsPDA)患儿和非hsPDA患儿各60例。比较两组患儿的临床特征及血小板相关指标,采用多元Logistic回归分析各因素对hsPDA发生的影响,采用受试者工作特征曲线分析相关指标对hsPDA的早期预测价值。结果hsPDA组胎龄、出生体重、1minApgar评分、剖宫产和母亲子痫比例、平均血小板体积与血小板分布宽度(platelet distribution width,PDW)均低于非hsPDA组,动脉导管直径、动脉到管直径2/体重大于非hsPDA组,生后6h内胸部X线片新生儿呼吸窘迫综合征分级重于非hsPDA组,肺表面活性物质使用率高于非hsPDA组,差异均有统计学意义(P<0.05)。多元Logistic回归分析提示PDW越低,发生hsPDA的风险越大(OR=1.240,95%CI1.011~1.521)。PDW最佳诊断界值为12.9%,对hsPDA早期预测的敏感度为53.3%,特异度为78.3%。结论PDW对早产儿hsPDA具有一定的早期预测价值,PDW<12.9%的早产儿需高度警惕hsPDA。

Objective To study the predictive value of platelet index on hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants. Method The data of 120 preterm infants born between January 2015 and December 2016 were retrospective analyzed, including 60 cases of non-hsPDA (nhsPDA) group and 60 cases of hsPDA group. The clinical features and platelet associated indicators between nhsPDA group and nhsPDA group were compared. Multivariate Logistic regression was used to analyze the effects of various factors on the occurrence of hsPDA. Receiver operating characteristic (ROC) curve was used to evaluate the early predictive value of platelet associated indicators for hsPDA. Result The hsPDA group had statistically significant differences in many parameters (P<0.05) comparing with the nhsPDA group, including smaller gestational age, lower birth weight and Apgar′s score (1min and 5min), lower proportion of cesarean section and preeclampsia, lower mean platelet volume and platelet distribution width (PDW), bigger PDA diameter and diameter2/birth weight, more serious respiratory distress syndrome, and a higher rate of pulmonary surfactant use. Multivariate Logistic regression analysis indicated that the risk of hsPDA was increased as the PDW decreased (OR=1.240, 95%CI 1.011~1.521). The ROC curve analysis showed that the best diagnostic value of PDW was 12.9%, and the sensitivity of early prediction of hsPDA was about 53.3%, and the specificity was 78.3%. Conclusion PDW has certain early predictive value for hsPDA in preterm infants. Preterm infants with PDW<12.9% need to be monitored closely for the occurrence of hsPDA.