肺炎支原体肺炎合并胸腔积液患儿体内凝血功能变化分析

目的：探讨肺炎支原体肺炎（MPP）合并胸腔积液患儿体内凝血功能的变化及发病机制，为治疗提供依据。方法收集132例MPP患儿以及60例MPP合并胸腔积液患儿的临床资料，回顾性分析患儿的一般性特征，对感染组、恢复组及对照组进行凝血酶原时间（PT）、国际标准化比值（INR）、活化部分凝血活酶时间（APTT）、纤维蛋白原含量（FIB）和凝血酶时间（TT）及血浆D-二聚体（DD）的检测，分析三组儿童各项凝血功能指标变化。结果两组患儿感染组较恢复组、对照组PT、APTT缩短，差异均有统计学意义（P〈0.05），而恢复组与对照组比较差异无统计学意义（P〉0.05）；感染组、恢复组、对照组三组FIB、DD两两比较差异均有统计学意义（P〈0.05）；而INR、TT三组两两比较差异无统计学意义（P〉0.05）；MPP组、MPP合并胸腔积液组两组比较：PT、APTT、TT、INR两组比较差异均无统计学意义（P〉0.05），MPP合并胸腔积液组DD、FIB结果明显高于MPP组，两者比较差异具有统计学意义（P〉0.05）；病情的变化趋势，MPP组以及MPP合并胸腔积液患儿感染期体内DD升高的比例均明显高于恢复期（P〈0.01）。结论 MPP以及MPP合并胸腔积液患儿PP、APTT缩短，FIB、DD明显升高，提示有潜在的可能激活外源性和内源性凝血系统，从而引起或促进血栓形成；DD可以作为反映MPP以及MPP合并胸腔积液患儿血液高凝状态的检测指标以及预后观察指标。

Objective 132 cases of children with MPP and 60 cases of MPP with pleural effusion in children with clinical data were collected and reviewed, the general characteristics of children,the infection period,recovery period and the control group of prothrombin time（PT）, international normalized ratio（INR）,activated partial thromboplastin time（APTT）,fibrinogen（FIB）and thrombin time（TT）and the plasma levels of D-dimer（DD）were detected,analysis was made on the changes of blood coagulation indexes of three groups of children.Results PT, APTT were shortened in groups of infection and the group of recovery group,compared with those in control group,the difference was statistically significant（P〈0.05）,while comparing the recovery group with the control group , the difference were not statistically significant（P〉0.05）;during infection stage,recovery period,the control group of three groups of FIB,DD 22 were statistically significant differences（P〈0.05）; and INR,TT 3 showed no statistical significance between any two groups comparison（P〉0.05）; MPP group,the MPP with pleural effusion group two groups：Pt,APTT,TT,INR difference between the two groups had no statistical significance（P〉0.05）,MPP with pleural effusion in the DD group and FIB were significantly higher than that in MPP group,the difference has statistical significance（P〉0.05）; the changing trend of the disease,the MPP group and MPP with pleural effusion in children were infected in the stage of DD elevated ratio were significantly higher than those in recovery period（P〈0.01）.Conclusion MPP and MPP with pleural effusion in children with have shortened PT, APTT,while the FIB and DD were significantly increased,suggesting potential activation of the intrinsic and extrinsic coagulation system,thus causing or promoting the formation of blood clots,DD can reflect the MPP and the MPP with pleural effusion in children with blood hypercoagulable state of test results and outcomes.