早产儿支气管肺发育不良形成过程中血小板动态监测
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摘要
目的 探讨血小板与早产儿支气管肺发育不良(BPD)之间的关系。方法 应用回顾性病例对照研究,对2013年1月-2017年4月首都医科大学附属北京友谊医院收治的出生胎龄≤32周并存活28 d以上的早产儿临床资料和血小板四项进行统计和分析。病例组为根据BPD诊断标准诊断BPD的早产儿,对照组为非BPD的早产儿。分别对住院期间血小板计数(PLT)、血小板分布宽度(PDW)、平均血小板体积(MPV)、血小板压积(PCT)的平均值及住院≤7 d、7<～14 d和14<～21 d血小板四项平均值进行统计。结果 本研究中≤32周并存活28 d以上的早产儿共有87例,最终纳入研究的患儿79例,30例BPD患儿为病例组,49例非BPD患儿为对照组。病例组胎龄及出生体重均较对照组患儿显著减低。病例组与对照组住院期间血小板四项平均值进行比较,病例组血小板计数(PLT)及血小板压积(PCT)的平均值较对照组显著减低(P=0.008、0.003)。病例组与对照组生后7 d内血小板四项平均值进行比较,病例组平均血小板体积(MPV)较对照组显著减小(P<0.001)。结论 早产儿肺部微血管的形成及发育在BPD的发生方面发挥重要作用,而血小板可能在此过程中扮演重要角色。
Objective To investigate the relationship between platelet and preterm infant with bronchopulmonary dysplasia(BPD). Methods Data of premature infants with gestational age less than 32 weeks,and living more than 28 days in Beijing Friendship Hospital were retrospectively analyzed from January 2013 to April 2017.Children were classified into case group and control group according to the BPD diagnosis.The mean values of four indexes of platelet during hospitalization,including platelet count(PLT),platelet width(PDW),mean platelet volume(MPV) and platelet count(PCT),and those at ≤7 days,7<-14 days and 14<-21 days were analyzed. Results Totally 87 preterm infants met the inclusion criteria,and 79 cases were included in this study finally.There were 30 cases in BPD group(case group) and 49 cases in non-BPD group(control group).The gestational age and birth weight in case group were significantly lower than those in control group(P<0.001).The levels of PLT and PCT in case group were significantly decreased compared with control group(P=0.008,0.003).And the level of MPV in case group significantly lower than that in control group in 7 days after birth(P<0.001). Conclusion The formation and development of pulmonary micro vessels play an important role in the development of BPD,and platelets may be the key role in this process of BPD.
Objective To investigate the relationship between platelet and preterm infant with bronchopulmonary dysplasia(BPD). Methods Data of premature infants with gestational age less than 32 weeks,and living more than 28 days in Beijing Friendship Hospital were retrospectively analyzed from January 2013 to April 2017.Children were classified into case group and control group according to the BPD diagnosis.The mean values of four indexes of platelet during hospitalization,including platelet count(PLT),platelet width(PDW),mean platelet volume(MPV) and platelet count(PCT),and those at ≤7 days,7<-14 days and 14<-21 days were analyzed. Results Totally 87 preterm infants met the inclusion criteria,and 79 cases were included in this study finally.There were 30 cases in BPD group(case group) and 49 cases in non-BPD group(control group).The gestational age and birth weight in case group were significantly lower than those in control group(P<0.001).The levels of PLT and PCT in case group were significantly decreased compared with control group(P=0.008,0.003).And the level of MPV in case group significantly lower than that in control group in 7 days after birth(P<0.001). Conclusion The formation and development of pulmonary micro vessels play an important role in the development of BPD,and platelets may be the key role in this process of BPD.
引文
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[13] 早产儿支气管肺发育不良调查协作组.早产儿支气管肺发育不良发生率及高危因素的多中心回顾调查分析[J].中华儿科杂志,2011,49(9):655-662.
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[15] 尹燕丹,祁媛媛,洪达,等.早产儿支气管肺发育不良危险因素及2岁时随访结局[J].中国循证儿科杂志,2016,11(2):113-117.
[16] 张国强,刘欣,刘曼,等.新生儿支气管肺发育不良从经典到新型的研究进展[J].中国儿童保健杂志,2015,23(11):1163-1165.
[17] Merritt TA,Deming DD,Boynton BR.The ′new′ bronchopulmonary dysplasia:challenges and commentary[J].Semin Fetal Neonatal Med,2009,14(6):345-357.
[18] Abman S H.Bronchopulmonary dysplasia:"a vascular hypothesis"[J].Am J Respir Crit Care Med,2001,164(10 Pt 1):1755-1756.
[19] Onwuka E,Best C,Sawyer A,et al.The role of myeloid cell-derived PDGF-B in neotissue formation in a tissue-engineered vascular graft[J].Regen Med,2017,12(3):249-261.
[20] 杨金萍,朱秀云,丁旭.慢性肾功能衰竭血小板参数测定的临床意义[J].临床检验杂志,2000,18(2):121.
[21] Dani C,Poggi C,Barp J,et al.Mean platelet volume and risk of bronchopulmonary dysplasia and intraventricular hemorrhage in extremely preterm infants[J].Am J Perinatol,2011,28(7):551-556.
[2] 茹喜芳,王颖,谢生勇,等.早产儿支气管肺发育不良发病及随访情况分析[J].中华实用儿科临床杂志,2017,32(2):100-104.
[3] Munoz-Hernandez R,Miranda ML,Stiefel P,et al.Decreased level of cord blood circulating endothelial colony-forming cells in preeclampsia[J].Hypertension,2014,64(1):165-171.
[4] Guclu E,Durmaz Y,Karabay O.Effect of severe sepsis on platelet count and their indices[J].Afr Health Sci,2013,13(2):333-338.
[5] 邓刚,胡海燕,杨华英.窒息新生儿血小板参数与脑血流动力学变化的关系及临床意义[J].中国妇幼保健,2014,29(30):4938-4939.
[6] 中华医学会儿科学分会新生儿学组,中华医学会中华儿科杂志编辑委员会.新生儿败血症诊疗方案[J].中华儿科杂志,2003.41(12):897-899.
[7] 中华医学会血液学分会血栓与止血学组.弥散性血管内凝血诊断与治疗中国专家共识(2012年版)[J].中华血液学杂志,2012,33(11):978-979.
[8] Egerman RS,Sibai BM.HELLP syndrome[J].Clin Obstet Gynecol,1999,42(2):381-389.
[9] 中华医学会围产医学分会新生儿复苏学组.新生儿窒息诊断的专家共识[J].中华围产医学杂志,2016,19(1):3-6.
[10] Vom HM,Prenzel F,Uhlig HH,et al.Pulmonary outcome in former preterm,very low birth weight children with bronchopulmonary dysplasia:a case-control follow-up at school age[J].J Pediatr,2014,164(1):40-45.
[11] Lapcharoensap W,Gage SC,Kan P,et al.Hospital variation and risk factors for bronchopulmonary dysplasia in a population-based cohort[J].JAMA Pediatr,2015,169(2):e143676.
[12] Jo HS,Cho KH,Cho SI,et al.Recent changes in the incidence of bronchopulmonary dysplasia among very-low-birth-weight infants in Korea[J].J Korean Med Sci,2015,30 (Suppl 1):81-87.
[13] 早产儿支气管肺发育不良调查协作组.早产儿支气管肺发育不良发生率及高危因素的多中心回顾调查分析[J].中华儿科杂志,2011,49(9):655-662.
[14] Klinger G,Sokolover N,Boyko V,et al.Perinatal risk factors for bronchopulmonary dysplasia in a national cohort of very-low-birthweight infants[J].Am J Obstet Gynecol,2013,208(2):111-115.
[15] 尹燕丹,祁媛媛,洪达,等.早产儿支气管肺发育不良危险因素及2岁时随访结局[J].中国循证儿科杂志,2016,11(2):113-117.
[16] 张国强,刘欣,刘曼,等.新生儿支气管肺发育不良从经典到新型的研究进展[J].中国儿童保健杂志,2015,23(11):1163-1165.
[17] Merritt TA,Deming DD,Boynton BR.The ′new′ bronchopulmonary dysplasia:challenges and commentary[J].Semin Fetal Neonatal Med,2009,14(6):345-357.
[18] Abman S H.Bronchopulmonary dysplasia:"a vascular hypothesis"[J].Am J Respir Crit Care Med,2001,164(10 Pt 1):1755-1756.
[19] Onwuka E,Best C,Sawyer A,et al.The role of myeloid cell-derived PDGF-B in neotissue formation in a tissue-engineered vascular graft[J].Regen Med,2017,12(3):249-261.
[20] 杨金萍,朱秀云,丁旭.慢性肾功能衰竭血小板参数测定的临床意义[J].临床检验杂志,2000,18(2):121.
[21] Dani C,Poggi C,Barp J,et al.Mean platelet volume and risk of bronchopulmonary dysplasia and intraventricular hemorrhage in extremely preterm infants[J].Am J Perinatol,2011,28(7):551-556.