血小板参数在儿童脓毒血症诊断与预后评估中的价值分析

Value analysis of platelet parameters in diagnosis and prognosis in children with sepsis

目的探讨血小板参数在儿童脓毒血症诊断与预后评估中的价值。方法以厦门大学附属第一医院2019年6月至2020年9月收治的70例脓毒血症患儿为研究对象进行前瞻性研究。检测所有患儿确诊当天及确诊第3天的血小板计数(PLT)、血小板比容(PCT)、血小板平均体积(MPV)、血小板分布宽度(PDW),计算MPV/PLT、MPV/PCT、PDW/PLT、PDW/PCT及确诊第3天PLT和MPV变化值(ΔPLT_(d3)、ΔMPV_(d3)),比较不同诊断、不同预后患儿确诊当天血小板参数及其比值,采用Logistic回归模型分析患儿死亡的影响因素,比较不同诊断及不同预后ΔPLT_(d3)、ΔMPV_(d3)患儿数的差异。结果脓毒性休克组确诊当天PLT低于脓毒血症组(P<0.05);治愈组PLT、PCT高于死亡组(P<0.05),MPV、MPV/PLT、MPV/PCT、PDW/PLT、PDW/PCT低于死亡组(P<0.05)。增高的MPV与ΔMPV_(d3)是脓毒血症患儿死亡的危险因素(OR=7.041、1.124,P<0.05)。脓毒性休克组ΔPLT_(d3)<0的患儿数多于脓毒血症组(P<0.05);不同预后ΔPLT_(d3)与ΔMPV_(d3)患儿数差异无统计学意义(P>0.05)。结论脓毒血症治愈的患儿与死亡的患儿多个血小板参数及比值存在明显差异,特别是MPV与ΔMPV_(d3)与预后相关,可以作为指导临床治疗的标志物。

Objective To investigate the value of platelet parameters in the diagnosis and prognosis in children with sepsis.Methods A prospective study was conducted on 70 children with sepsis treated in the First Affiliated Hospital of Xiamen University from June 2019 to September 2020.The platelet count(PLT),plateletcrit(PCT),mean platelet volume(MPV)and platelet distribution width(PDW)of all children on the first day of diagnosis and on the third day of diagnosis were detected.MPV/PLT,MPV/PCT,PDW/PLT,PDW/PCT and the changes of PLT and MPV on the third day of diagnosis(ΔPLT_(d3) andΔMPV_(d3))were calculated.The platelet parameters and their ratios on the first day of diagnosis were compared in children with different diagnoses and different prognosis.The influencing factors of death of children were analyzed by Logistic regression model,and the differences of the number of children withΔPLT_(d3) andΔMPV_(d3) with different diagnosis and prognosis were compared.Results The PLT in the septic shock group was lower than that in the sepsis group on the first day of diagnosis(P<0.05).The PLT and PCT in the cured group were higher than those in the dead group(P<0.05),and MPV,MPV/PLT,MPV/PCT,PDW/PLT and PDW/PCT were lower than those in the dead group(P<0.05).Increasing MPV andΔMPV_(d3) were risk factors for death in children with sepsis(OR=7.041,1.124,P<0.05).The number of children withΔPLT_(d3)<0 in the septic shock group was more than that in the sepsis group(P<0.05);there were no statistical signifcance in the difference of the number of children withΔPLT_(d3) andΔMPV_(d3) with different prognosis(P>0.05).Conclusion There are significant differences in platelet parameters and ratios between cured and dead children with sepsis.In particular MPV andΔMPV_(d3) are related to prognosis,and they can be used as markers to guide clinical treatment.