中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2012年
12期
948-952
,共5页
P选择素%重症监护,儿科%肺炎%血液凝固障碍
P選擇素%重癥鑑護,兒科%肺炎%血液凝固障礙
P선택소%중증감호,인과%폐염%혈액응고장애
P-selectin%Intensive care units,pediatric%Pneumonia%Blood coagulation disorders
目的 了解可溶性P选择素在儿童重症肺炎弥漫性血管内凝血(DIC)前状态的诊断价值.方法 运用前瞻性队列研究的方法,从2010年1月-2011年7月在福建省妇幼保健院儿童重症监护病房观察226例重症肺炎儿童(病例组75例,对照组151例)的可溶性P选择素、D二聚体、血小板、活化部分凝血酶原时间,凝血酶原时间,纤维蛋白原指标,绘制ROC曲线,评价可溶性P选择素在儿童重症肺炎DIC前状态的诊断价值.结果 病例组和对照组可溶性P选择素分别为124.8(26.9 ～608.3)μg/L和63.3(2.8 ～302.1)μg/L,D二聚体分别为1.3(0.7 ～ 16.0)mg/L和0.5(0.2 ～1.0) mg/L,血小板计数分别为91(56 ～ 196)×109和231(120 ～680)×109;活化部分凝血酶原时间(39.1 ±3.5)s、(37.2±2.4)s,凝血酶原时间(14.8±2.1)s、(13.0±0.5)s,纤维蛋白(3.8±0.5)g/L、(3.3 ±0.2)g/L,两组间差异均有统计学意义.根据ROC曲线下面积提示D二聚体、可溶性P选择素有较高的诊断价值,并确定可溶性P选择素诊断临界点为94.0 μg/L,敏感度为0.824,特异度为0.887,D二聚体诊断临界点为0.7 mg/L,敏感度为0.905,特异度为0.867,将可溶性P选择素、D二聚体系列试验特异度增加至0.920,一致性检验较好.结论 可溶性P选择素可作为DIC前状态的诊断参考指标之一,其与D二聚体高联合系列试验,在一定程度减少误诊率,提高筛查效率.
目的 瞭解可溶性P選擇素在兒童重癥肺炎瀰漫性血管內凝血(DIC)前狀態的診斷價值.方法 運用前瞻性隊列研究的方法,從2010年1月-2011年7月在福建省婦幼保健院兒童重癥鑑護病房觀察226例重癥肺炎兒童(病例組75例,對照組151例)的可溶性P選擇素、D二聚體、血小闆、活化部分凝血酶原時間,凝血酶原時間,纖維蛋白原指標,繪製ROC麯線,評價可溶性P選擇素在兒童重癥肺炎DIC前狀態的診斷價值.結果 病例組和對照組可溶性P選擇素分彆為124.8(26.9 ～608.3)μg/L和63.3(2.8 ～302.1)μg/L,D二聚體分彆為1.3(0.7 ～ 16.0)mg/L和0.5(0.2 ～1.0) mg/L,血小闆計數分彆為91(56 ～ 196)×109和231(120 ～680)×109;活化部分凝血酶原時間(39.1 ±3.5)s、(37.2±2.4)s,凝血酶原時間(14.8±2.1)s、(13.0±0.5)s,纖維蛋白(3.8±0.5)g/L、(3.3 ±0.2)g/L,兩組間差異均有統計學意義.根據ROC麯線下麵積提示D二聚體、可溶性P選擇素有較高的診斷價值,併確定可溶性P選擇素診斷臨界點為94.0 μg/L,敏感度為0.824,特異度為0.887,D二聚體診斷臨界點為0.7 mg/L,敏感度為0.905,特異度為0.867,將可溶性P選擇素、D二聚體繫列試驗特異度增加至0.920,一緻性檢驗較好.結論 可溶性P選擇素可作為DIC前狀態的診斷參攷指標之一,其與D二聚體高聯閤繫列試驗,在一定程度減少誤診率,提高篩查效率.
목적 료해가용성P선택소재인동중증폐염미만성혈관내응혈(DIC)전상태적진단개치.방법 운용전첨성대렬연구적방법,종2010년1월-2011년7월재복건성부유보건원인동중증감호병방관찰226례중증폐염인동(병례조75례,대조조151례)적가용성P선택소、D이취체、혈소판、활화부분응혈매원시간,응혈매원시간,섬유단백원지표,회제ROC곡선,평개가용성P선택소재인동중증폐염DIC전상태적진단개치.결과 병례조화대조조가용성P선택소분별위124.8(26.9 ～608.3)μg/L화63.3(2.8 ～302.1)μg/L,D이취체분별위1.3(0.7 ～ 16.0)mg/L화0.5(0.2 ～1.0) mg/L,혈소판계수분별위91(56 ～ 196)×109화231(120 ～680)×109;활화부분응혈매원시간(39.1 ±3.5)s、(37.2±2.4)s,응혈매원시간(14.8±2.1)s、(13.0±0.5)s,섬유단백(3.8±0.5)g/L、(3.3 ±0.2)g/L,량조간차이균유통계학의의.근거ROC곡선하면적제시D이취체、가용성P선택소유교고적진단개치,병학정가용성P선택소진단림계점위94.0 μg/L,민감도위0.824,특이도위0.887,D이취체진단림계점위0.7 mg/L,민감도위0.905,특이도위0.867,장가용성P선택소、D이취체계렬시험특이도증가지0.920,일치성검험교호.결론 가용성P선택소가작위DIC전상태적진단삼고지표지일,기여D이취체고연합계렬시험,재일정정도감소오진솔,제고사사효솔.
Objective Inflammation and coagulation occur concomitantly in severe pneumonia.The term non-overt disseminated intravascular coagulation (DIC) (pre-DIC state) refers to a state prevalent before the occurrence of overt DIC.It is suggested that initiation of treatment in non-overt DIC leads to better outcome than in overt DIC.The present study aimed at evaluating potential use of soluble P-selectin in diagnosis of pre-DIC state of children with severe pneumonia.Method The laboratory findings (including soluble P-selectin,D-Dimer,platelet count,activated partial prothrombin time,prothrombin time and fibrinogen)of 226 children with severe pneumonia from Jan.2010 to Jul.2011 in pediatric intensive care unit(PICU),were analyzed in this prospective cohort study,and the ROC curve was plotted to evaluate the potential role of soluble P-selectin in diagnosis of pre-DIC state.Result A total of 226 patients with severe pneumonia comprised of 75 positive and 151 negative pre-DIC state cases were enrolled.The mean value of soluble P-selectin,D-Dimer,and platelet count were 124.8 (26.9-608.3) μg/L,1.3 (0.7-16.0) mg/L and 91 (56-196) × 109 for the positive cases,and 63.3 (2.8-302.1) μg/L,0.5 (0.2-1.0) mg/L and 231(120-680) × 109 for the negative cases,respectively.There was a significant difference between the two groups.Coagulatory function in the positive cases,including activated partial prothrombin time,prothrombin time and fibrinogen which were (39.1 ± 3.5) see,(14.8 ± 2.1) sec and (3.8 ± 0.5) g/L,respectively,were significantly higher than those in the negative cases [(37.2 ±2.4) sec,(13.0 ±0.5)sec and (3.3 ± 0.2) g/L] (P ＜ 0.001).The area under ROC curve showed that D-dimer,soluble P-selectin for pre-DIC state had higher diagnostic value.The Optimal Operating Point of soluble P-selectin was determined and interpreted at 94.0 μg/L with a sensitivity of 0.824,a specificity of 0.887,and the Optimal Operating Point of D-dimer was determined and interpreted at 0.7 mg/L with a sensitivity of 0.905,a specificity of 0.867,systematic test of soluble P-selectin and D-dimer had a higher specificity of 0.920,determined at the same time.Conclusion To improve the outcome of patients with DIC,there is a need to establish more useful and easily operative diagnostic criteria for pre-DIC state.Plasma levels of soluble P-selectin will be helpful in this respect.Systematic test of soluble P-selectin and D-dimer may be helpful in reducing misdiagnosis rate.
