临床儿科杂志 ›› 2017, Vol. 35 ›› Issue (4): 273-.doi: 10.3969/j.issn.1000-3606.2017.04.008

• 综合报道 • 上一篇    下一篇

血小板相关指标对超低出生体质量儿动脉导管未闭的早期预测价值

钟隽镌, 姚仲伟, 莫镜, 张静, 杨杰   

  1. 广东省妇幼保健院(广东广州 510000)
  • 收稿日期:2017-04-15 出版日期:2017-04-15 发布日期:2017-04-15
  • 通讯作者: 杨杰 E-mail:jieyang0830@163 .com

Early predictive value of platelet related indicators in patent ductus arteriosus in extremely low birth weight infants

ZHONG Junjuan, YAO Zhongwei, MO Jing, ZHANG Jing, YANG Jie   

  1. Guangdong Women and Children Hospital, Guangzhou 511400, Guangdong, China
  • Received:2017-04-15 Online:2017-04-15 Published:2017-04-15

摘要: 目的 分析血小板相关指标对于超低出生体质量儿(ELBW)动脉导管未闭(PDA)的早期预测价值。方法  回顾分析2013年6月至2016年6月收治的79例ELBW患儿,其中无PDA48例(nPDA组),PDA 31例(PDA组);31例 PDA患儿中,无血流动力学意义的PDA(nhsPDA组)17例,有血流动力学意义的PDA(hsPDA组)14例。比较nPDA组与 PDA组,以及nhsPDA组与hsPDA组的临床特征及血小板相关指标,采用多元logistic回归模型分析各因素对PDA发生的 影响。采用ROC曲线分析相关指标对PDA的早期预测价值。结果 与nPDA组相比较,PDA组胎龄小,男婴比例高,血小 板分布宽度(PDW)小,差异有统计学意义(P均<0.05)。多元logistic回归分析提示PDW越低,发生PDA风险越大(OR=1.26, 95%CI:1.05~1.52)。ROC曲线分析发现,PDW最佳诊断界值为13.4 GSD,对PDA早期预测灵敏度为67.74%,特异 度为68.75%。hsPDA组胎龄小于nhsPDA组,剖宫产比例低于nhsPDA组,差异有统计学意义(P均<0.05),hsPDA组与 nhsPDA组间血小板相关指标差异无统计学意义(P均>0.05)。 结论 PDW对ELBW的PDA具有一定的早期预测价值, 伴PDW<13.4 GSD的ELBW,需高度警惕PDA。

Abstract: Objective To analyze the predictive value of platelet related indicators for patent ductus arteriosus (PDA) in extremely low birth weight infants (ELBW). Methods The data of 79 ELBW infants born from June 2013 to June 2016 were retrospective analyzed. There were 48 cases without PDA (nPDA group) and 31 cases with PDA (PDA group). Among 31 cases with PDA, there were 17 cases of non-haemodynamically significant PDA (nhsPDA group) and 14 cases of haemodynamically significant PDA (hsPDA group). The clinical feature and platelet related indicators among nPDA group, PDA group, nhsPDA group and hsPDA group were compared. Multivariate logistic regression was used to analyze the effects of various factors on the occurrence of PDA. ROC curve analysis was performed to evaluate the early predictive value of platelet related indicators for PDA. Results Compared with the nPDA group, the PDA group had a smaller gestational age, a higher proportion of male infants, and a smaller platelet distribution width (PDW), and there were statistically significant differences in all of those (P all<0.05). Multivariate logistic regression analysis indicated that the risk of PDA was increased as the PDW was decreased (OR=1.26, 95%CI: 1.05~1.52). The ROC curve analysis showed that the best diagnostic value of PDW was 13.4 GSD, and the sensitivity of early prediction of PDA was about 67.74%, and the specificity was 68.75%. Compared with nhsPDA group, hsPDA group had a smaller gestation age, lower cesarean section rate, and there were statistically significant differences (P all<0.05). There was no significant difference in platelet related indicators between hsPDA group and nhsPDA group (P>0.05). Conclusion PDW has certain early predictive value for PDA in ELBW. ELBW infants with PDW<13.4 GSD need to be watched closely for the occurrence of PDA.