血小板及其他实验室指标在新生儿败血症早期诊治中的应用研究

Application of Platelet and Other Laboratory Indicators in Early Diagnosis and Treatment of Neonatal Sepsis

目的观察血小板计数(PLT)、血小板平均容积(MPV)、血小板分布宽度(PDW)、血小板压积(PCT)、大血小板比率(PLCR)、血生化和CRP等参数在新生儿败血症患者的变化,探讨其在快速简便诊治新生儿败血症中的评估价值。方法按照新生儿败血症诊断标准,选取2016年3月~2017年4月收治的血培养阳性的新生儿88例作为研究对象(A组),选择同期入住的、非感染性疾病新生儿88例为对照组(B组);根据病情严重程度、参照新生儿休克评分标准判断是否合并休克将病例A组患儿又分为两个小组:A1组(临床病情较重,合并休克,休克评分>6分)和A2组(临床病情较轻微,未合并休克或合并休克但休克评分≤6分)。对其及B组展开血小板和血生化、CRP等指标的动态监测,并对监测结果进行统计学分析。结果 A组和B组新生儿患者的血常规及血生化检测结果中PLT、Hb、MCV在A组较B组显著降低,而CRP、TBIL、DBIL、BUN在A组较B组显著升高;多参数的二元Logistic回归分析,得到回归方程拟合结果。其中PLT、MCV、CRP、TBIL、BUN进入回归方程,而WBC计数及血红蛋白、直接胆红素均未进入回归方程,PLT、MCV、CRP、TBIL、BUN与新生儿败血症的诊断密切相关;A1组较A2组血小板计数显著降低,差异具有统计学意义(P<0.05)。结论 PLT、TBIL,CRP、BUN、MCV等实验室指标均对败血症的早期诊断有指导意义,其中血小板参数变化对新生儿败血症的发生、发展及预后有一定的预测价值,在临床诊治中应予重视,值得推广使用。

Objective To observe the changes of platelet count （PLT）, mean platelet volume （MPV）, platelet distribution width （PDW）, platelet pressure （PCT）, large platelet ratio （PLCR） and blood biochemistry, CRP and other parameters in neonatal sepsis patients In order to explore its value in the quick and easy diagnosis and treatment of sepsis. Methods According to the diagnostic criteria of neonatal sepsis, 88 newborns with blood culture positive who were treated from March 2016 to April 2017 were selected as the study group （A group）, 88 newborns with noninfectious disease （Group B）; according to the severity of the disease, with reference to neonatal shock score criteria to determine whether the combined shock in group A children were further divided into two groups： A1 group （severe clinical conditions, with shock, shock score 〉 6 points） and A2 group （clinical condition is mild, not combined with shock or shock but shock score≤ 6 points）. The control group and its dynamic platelet and blood biochemical, CRP and other indicators of dynamic monitoring, and monitoring results were statistically analyzed. Results The levels of PLT, Hb and MCV in group A and B were significantly lower in group A than those in group B, while the levels of CRP, TBIL, DBIL and BUN were significantly higher in group A than those in group B; Binary logistic regression analysis of multiple parameters to get the regression equation fitting results. The PLT, MCV, CRP, TBIL and BUN entered the regression equation, and the WBC count, hemoglobin and direct bilirubin did not enter the regression equation. The PLT, MCV, CRP, TBIL and BUN were closely related to the diagnosis of neonatal sepsis. Compared with A2 group, the platelet count decreased significantly （P 〈0.05）. Conclusion The laboratory indexes of PLT, TBIL, CRP, BUN and MCV are both instructive in the early diagnosis of sepsis. The changes of platelet parameters have some predictive value in the occurrence, development and prognosis of neonatal sepsis. To pay attention, it is worth promoting the use of.