血浆D-二聚体水平变化在新生儿继发性肺动脉高压中的应用价值

Application value of plasma D-dimer level change in neonatal secondary pulmonary hypertension

目的探讨血浆D-二聚体水平在新生儿继发性肺动脉高压(PH)中的应用价值。方法选取2020年6月至2023年5月该院新生儿科收治的106例PH患儿为观察组,并分为轻度PH亚组46例、中重度PH亚组22例、新生儿持续肺动脉高压(PPHN)及PH合并肺出血亚组38例,选取同期胎龄、入组日龄、性别、出生体质量、分娩方式、基础疾病、氧疗方式等一般情况与观察组匹配,无PH组需接受机械通气辅助治疗的50例新生儿为对照组。采用酶联免疫荧光法检测患儿血浆D-二聚体水平,比较各组血浆D-二聚体水平及阳性率,分析血浆D-二聚体水平与肺动脉收缩压(PASP)的关系。结果对照组、轻度PH亚组、中重度PH亚组、PPHN及PH合并肺出血亚组D-二聚体水平分别为(780.91±362.10)、(1839.67±863.30)、(4203.26±2889.06)、(6229.38±3061.87)ng/mL,各组血浆D-二聚体水平比较,差异有统计学意义(F=66.172,P<0.01),进一步进行两两比较,差异均有统计学意义(P<0.01)。患儿血浆D-二聚体水平与PASP呈正相关(r=0.584,P<0.01)。轻度PH亚组、中重度PH亚组、PPHN及PH合并肺出血亚组D-二聚体阳性率均高于对照组,差异有统计学意义(P<0.01),但观察组各亚组间的阳性率比较,差异无统计学意义(P>0.05)。结论血浆D-二聚体可作为一种用于判断新生儿继发性PH是否与血液呈高凝状态或血管内梗阻有关的生化标志物。

Objective To study the value of plasma D-dimer level in neonates with secondary pulmonary hypertension(PH).Methods A total of 106 children with PH admitted to the Department of Neonatology,Huadu Hospital Affiliated to Southern Medical University/Huadu District People′s Hospital of Guangzhou from June 2020 to May 2023 were selected as the research objects in observation group.They were divided into mild PH subgroup(46 cases),moderate to severe PH subgroup(22 cases),and newborn with persistent pulmonary hypertension(PPHN)and PH with pulmonary hemorrhage subgroup(38 cases).During the same period,50 neonates without PH requiring assisted mechanical ventilation matched with the observation group in gestational age,age in days at enrollment,gender,birth weight,delivery mode,underlying diseases and oxygen therapy were selected as the control group.The plasma D-dimer level was detected by enzyme-linked immunofluorescence method.The plasma D-dimer level and positive rate of each group were compared,the relationship between plasma D-dimer level and pulmonary artery systolic pressure(PASP)was analyzed.Results The levels of D-dimer in the control group,mild PH subgroup,moderate to severe PH subgroup,PPHN and PH with pulmonary hemorrhage subgroup were(780.91±362.10),(1839.67±863.30),(4203.26±2889.06)and(6229.38±3061.87)ng/mL respectively,the difference of plasma D-dimer level in each group was statistically significant(F=66.172,P<0.01),further pairwise comparison,the difference of any 2 groups comparison was statistically significant(P<0.01).The plasma D-dimer level correlated positively with PASP(r=0.584,P<0.01).The positive rates of D-dimer in the mild PH subgroup,the moderate to severe PH subgroup,the PPHN and PH with pulmonary hemorrhage subgroup were higher than that in the control group,the differences were statistically significant(P<0.01),but there was no statistically significant difference on the positive rate between the subgroups in observation(P>0.05).Conclusion Plasma D-dimer can be used as a biochemical marker to determine whether neonatal secondary PH relates to intravascular obstruction.