血小板聚集功能预测早产儿动脉导管持续开放的价值

Predictive value of platelet aggregation rate in hemodynamically significant patent ductus arteriosus in preterm infants

目的探讨血小板聚集功能预测早产儿动脉导管持续开放的价值。方法前瞻性选择徐州中心医院新生儿重症监护病房2017年8月至2019年10月收治的出生胎龄<32周早产儿72例进行巢氏病例对照研究。生后第4~5天完成超声心动图检查,将符合有血流动力学意义的动脉导管未闭(hsPDA)诊断标准的早产儿纳入hsPDA组,按照1∶2匹配非hsPDA早产儿作为对照组。记录早产儿基本特征,检测血常规和血小板聚集功能。选用独立样本t检验和χ²检验进行数据的组间比较,二元Logistic回归分析和受试者工作特征曲线分析危险因素和预测价值。结果最终纳入hsPDA组24例(男16例),匹配对照组48例(男30例)。hsPDA组≥Ⅱ级新生儿呼吸窘迫综合征的比例高于对照组[67%(16/24)比27%(13/48),χ^(²)=10.422,P=0.001]。hsPDA组血小板压积和二磷酸腺苷诱导血小板聚集率均低于对照组(0.0021±0.0009比0.0028±0.0009、0.21±0.10比0.32±0.07,t=-3.043、-5.093,P=0.004、<0.01),血小板平均体积大于对照组[(10.3±2.4)比(9.2±2.0)fl,t=2.713,P=0.033]。其他血小板参数(血小板计数、血小板分布宽度和大血小板比率)及诱导剂(胶原、肾上腺素和花生四烯酸)诱导血小板聚集率两组差异均无统计学意义(均P>0.05)。二磷酸腺苷诱导血小板聚集率低和血小板压积低是早产儿发生hsPDA的独立危险因素(OR=4.525、3.994,95%CI:1.305~15.689、1.143~13.958)。二磷酸腺苷诱导血小板聚集率具有预测早产儿发生hsPDA的中等价值(受试者工作特征曲线下面积为0.809,最佳预测界值为0.245,敏感度为0.67,特异度为0.86)。结论血小板聚集功能差和血小板压积低是出生胎龄<32周早产儿发生hsPDA的独立危险因素。血小板聚集功能预测早产儿动脉导管持续开放的价值中等。

Objective To explore the predictive value of platelet aggregation rate in patent ductus arteriosus in preterm infants.Methods This prospective nested case-control study enrolled 72 preterm infants with gestational age<32 weeks,who were admitted to Neonatal Intensive Care Unit of Xuzhou Central Hospital from August 2017 to October 2019.The echocardiography was performed on the 4^(th) to 5^(th) day after birth,and the preterm infants who met the diagnostic criteria of hemodynamically significant patent ductus arteriosus(hsPDA)were included into hsPDA group,and the control group was comprised of matched preterm infants with non-hsPDA according to the proportion of 1∶2.The basic characteristics of the preterm infants were recorded,and their complete blood counts and platelet aggregation function were examined.Clinical data were compared by student′s t test and chi-square test between the two groups.The risk factors and their predictive values were analyzed by binary logistic regression analysis and receiver operating characteristic curve.Results There were 24 preterm infants(16 boys)in the hsPDA group,and 48(30 boys)in the control group.The incidence of neonatal respiratory distress syndrome(NRDS)grade II-IV in the hsPDA group was higher than that in the control group(67%(16/24)vs.27%(13/48),χ^(²)=10.422,P=0.001).The thrombocytocrit and adenosine diphosphate-induced platelet aggregation rate in the hsPDA group were lower than those in the control group(0.0021±0.0009 vs.0.0028±0.0009,0.21±0.10 vs.0.32±0.07,t=-3.043 and-5.093,P=0.004 and<0.01,respectively);while the platelet volume in the hsPDA group was greater than that in the control group((10.3±2.4)vs.(9.2±2.0)fl,t=2.713,P=0.033).The other platelet parameters(platelet count,platelet distribution width,and large platelet ratio)and platelet aggregation rate induced by other inducers(collagen,epinephrine and arachidonic acid)were not significantly different between the two groups(all P>0.05).The low platelet aggregation rate induced by adenosine diphosphate and low thrombocytocrit were independent risk factors for hsPDA in preterm infants(OR=4.525 and 3.994,95%CI:1.305-15.689 and 1.143-13.958,respectively).And the adenosine diphosphate-induced platelet aggregation rate had moderate predictive value for hsPDA in preterm infants,as the area under the receiver operating characteristic curve was 0.809,and the cutoff value was 0.245 with 0.67 sensitivity and 0.86 specificity.Conclusions Poor platelet aggregation function and low thrombocytocrit are independent risk factors for hsPDA in preterm infants with gestational age<32 weeks.Low platelet aggregation rate induced by adenosine diphosphate has moderate predictive value for hsPDA patency.