凝血功能指标对危重症患儿的诊断价值

Clinical significance of blood coagulation status in critically ill children diagnosis

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.